Claims Submission

Please submit your claim directly to us via this form. The Avery Dennison Reflective Claims Department will get in touch with you to help resolve your issue.

Account Information

Customer Name/Company Account #

Contact Name


Street, City, State, Zip, Country

Geographic Region



Claim Information

Avery Dennison Sales Order #

Avery Dennison Invoice #/Purchase Order #

Avery Dennison Lot #/ Watermark #—REQUIRED for Quality Type Claims

Value of Credit Amount Requested (USD)

Description of Issue

Quantity of Items/Unit of Measure (UoM) (ie - Rolls/Bottles/Cartridges/Bags). Please indicate the product/part#

Are you requiring a Return of Material (RMA)?

Pickup Address/Hours/Contact Names & Phone #

Is a Replacement Order required?

If you require a Replacement Order, please indicate the PO # for reference

Replacement Order Quantity/Product/Unit of Measure (3 Rolls 0650000A1 T-6500 HIP WHT 48" x 50YD/5 1L Bottles Cyan Ink X10196)

Is this a pricing issue?

Specify the correct Price for each item in question and include Quote # or Special Pricing Agreement #

Avery Dennison Sales Rep

Additonal Comments


Please forward any attachments and/or images to your regional contact.


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Please only click Submit ONCE. You may experience a slight delay in response.

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Please be aware that this information (including the original and the subsequent reply) may be transferred to a server located in the U.S. for metrics and storage. If you do not consent to this use of your personal information, please do not use the Claims Submission system.