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RxAuto Retreat Authorization Form

Retreats are only available during the 90-day warranty period.

Please completely fill out the following form. Any fields left blank will delay the processing of your retreat!

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    Please Read

    I am requesting a Thermagasket retreat in Lieu of refund. Acceptance of this retreat releases RxAuto Thermagasket LLC of any obligations under the expressed written warranty!

    I agree to be billed as follows for Shipping and Handling:

    Inside the United States $21.00
    Canada or Mexico $39.00

    Your Digital Signature acknowledges you agree to abide by the above terms

    Type Name Here

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    Once we have received this form you will be sent a password protected link within 24 hours to complete payment for Shipping & Handling. The password will be good for 24 hours.

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