Step
1
of
2
50%
Contact Information
Name
(Required)
First
Last
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
United States
Canada
Country
Email
(Required)
Phone
(Required)
Product Information
Product
(Required)
Lipo Flavonoid Ear Ringing 90ct
Lipo Flavonoid Ear Ringing 100ct
Lipo Flavonoid Ear Ringing 150ct
Lipo Flavonoid Ear Ringing 500ct
Lipo Flavonoid Balance Support 30ct
Lipo Flavonoid Hearing Support 30ct
Lipo Flavonoid Ear Ringing Day/Night Combo
Lipo Flavonoid Ear Ringing Night 75ct
Product Price
(Required)
If you purchased different count sizes of the same product upload your receipts for all. If you purchased different products, then you will need to submit separate refund requests for each product.
Lot Number
(Required)
Expiration Date
(Required)
MM/YY
Return Information
Reason
(Required)
Did not work
Medical
Other
Please Share Reason
(Required)
Purchase Date
(Required)
Month
Day
Year
Store Name
(Required)
Walmart
Walgreens
CVS
Kroger
Meijer
Publix
Rite Aid
Target
Amazon
Other
Please Share Store Name
(Required)
Proof of Purchase
(Required)
Please include an image of your receipt in order to verify your purchase(s).
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