Fields mark with * are required.

Laptop Battery Submission Form:

Customer Information

First Name*

Last Name*

Company Name

Address 1*

Address 2

City*

State/Province/Region*

Zipcode*

Country

Phone*

Fax

Email*

Laptop Battery Information

Purchased from*

Purchased date*

Kindly upload evidence of your order (.pdf).

Must provide proof of purchased*

Only PDF (.pdf) files allowed

Laptop model number*

Battery part number*

Battery serial number* (15 - 16 digits)

Reason for return*