Ship-To Equipment Refund Form

This form is ONLY for ship-to device returns.

Backend Form Name

GroupName

Subject

Do NOT enter the customer's email address in this field.

If a valid T-Mobile address is not entered, you will not receive any updates on the case

T-Mobile Employee NTID/ADID *

T-Mobile Employee Email Address *

Re-enter T-Mobile Employee Email Address *

Email Address does not Match. Please Re-enter.

HRT Form Filed? *

Is this request related to a PSO charge created on the bill for a Web/Virtual Retail/Telesales order?

HRT Form Filed and PSO charge cannot be 'No'

HRT Order # *

HRT Date Completed *

First Name *

Last Name *

BAN *

This field must contain 9 digit(s).

MSISDN / Mobile Number *

This field must contain 10 digit(s).

Last 4 digits of card or bank account number *

This field must contain 4 digit(s).

SAP / Telesales / Boss / Dash / Atlas Order Number *

Order Date *

Is this a partial refund request? *

Refund Amount Requested *

Return Order Date *

Return Order Number *

Is there any additional information we should know?

Enter the code from the image