IMIRROR Product Recall – Return Request Form

Thank you for your cooperation in our voluntary product recall.
Please complete the form below to receive a prepaid return shipping label. Once we receive the returned product, a full refund will be issued through Amazon. Please note that it may take a few business days for Amazon to process the refund and for the amount to appear in your original payment method. Your understanding and patience are greatly appreciated!

⚠️ Important Notes:

  • Refunds will only be processed through your original Amazon account.
  • We cannot issue refunds via other platforms or payment methods.
  • Refunds will only be processed after we have received the returned product.
  • Kindly send out your return within 30 days to ensure the label remains valid.

Email *
Full Name *

Email Address

*
We'll send your return label to this email.

Phone Number

*

Amazon Order Number

*

Please enter your full 17-digit Amazon order number.  
Example: 112-1234567-1234567  
You can find this number in your Amazon account under “Your Orders” or in your order confirmation email.

Additional Order Numbers
If you have more than one Amazon order number to report for this recall, please enter below. Leave blank if not applicable.

Date of Purchase

*
MM
/
DD
/
YYYY

Address Line 1

*
Please enter your full return shipping address below. This information will be used to generate your prepaid return label.

Address Line 2

City

*

State

*

ZIP

*

Country

*

Agreement

*
Required
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report