amika® Shampoo Recall Salon Entry Form

Directions: Please complete the form below to submit a request for product return. For best results, it is recommended that the form is completed on a mobile or tablet device with a rear-facing camera. You will need to take a photo of the recalled product to process your request. You will receive an email confirmation once submitted.

*If you're not on a device with a camera, you can scan the QR code with a mobile device to take you to this page.

*Salon Business Name:

*First Name:

*Last Name:

*Email Address:

*Reenter Email Address:

*Phone:

*Country:

*Street Address:

Apt, suite, or floor#:

*City:

*State/Province:

*Postal Code:

Distributor Business Name / Contact Name:

*Client ID:

*PO Number:

For each type of product to be reimbursed, select the product Packaging, Name, and enter the quantity you have on-hand. To add additional rows, select the '+' button at the end of the row.

	Packaging	Product Name	Quantity

You will need to box and ship the affected product back. For USA businesses, the email sent after submitting this form will have pre-paid FedEx labels attached. For Canadian businesses, an email will be sent from our support center within X business days with instructions and labels for shipping.

Next, please use a permanent marker to write the word "DAMAGED" across the front label of all units of affected product. You will then need to take a photo showing all affected product grouped together.

Please click the blue button below to enable your camera. Accept the permission if prompted. Take a photo as instructed. Click/tap the green capture buttons and view photo below.

If you need to re-take the photo, simply point the camera view at the products and click the green take photo button again.

or Upload Photo:

Photo of front labels

*I hereby certify that the above information regarding the quantity is true and accurate to the best of my knowledge.