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ORDER CLAIMS
ORDER NUMBER
(Required)
IE: #ElementaOrder - 63156
PRODUCT NAME
(Required)
Put the name of the missing or damaged product ie: 16oz Wintermint Mouth Rinse
LOT NUMBER
(Required)
Add the lot number as shown in the image below
SHIP TO ADDRESS
(Required)
Please put the address you wish to send the replacement product to.
Email Address
(Required)
ADDITIONAL NOTES OR COMMENTS
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