Return Authorization

This specific form is for US customer only. If you are an international customer interested in our customer repair service please contact the distributor in your country.

Return Authorization Form

We guarantee that your personal data will only be used by Chiappa Firearms and will not be divulged to any outer source.

Customer Information

Name: *

Address: *

Telephone #: *

E-mail address: *

Product Information

Model: *

Serial # of firearm: *

Caliber: *

Where purchased: *

Date of purchase: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

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Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050

Do you have a receipt or proof of purchase?: *

Yes

No

Description of problem/issue: *