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[fusion_form_number label="How many items do you wish to return?" name="how_many_items_do_you_wish_to_return" min="0" max="100" required="yes" placeholder="" tooltip="" input_field_icon="" tab_index="" class="" id="" logics="W3sib3BlcmF0b3IiOiJhbmQiLCJjb21wYXJpc29uIjoiZXF1YWwiLCJmaWVsZCI6InJlYXNvbl9vZl9pbnF1aXJ5IiwidmFsdWUiOiJSZXR1cm4gcXVlc3Rpb24ifV0=" /]
[fusion_form_date label="When did you purchase the items?" name="when_did_you_purchase_the_items" required="no" placeholder="" tooltip="" picker="custom" input_field_icon="" tab_index="" class="" id="" logics="W3sib3BlcmF0b3IiOiJhbmQiLCJjb21wYXJpc29uIjoiZXF1YWwiLCJmaWVsZCI6InJlYXNvbl9vZl9pbnF1aXJ5IiwidmFsdWUiOiJSZXR1cm4gcXVlc3Rpb24ifV0=" /]
[fusion_form_select label="What country do you need information about?" name="country_delivery" required="yes" placeholder="" tooltip="" 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