Customer Information (Customer fills out)

RA Number:________
Current date and your initials (e.g. 021105BD)

Company Name:_____________________ Address:_________________________
_________________________
Requested By:______________________

Title: ____________________________ Phone: _________________________

Part Number: ______________ Fax: _________________________

Quantity Returned:___________ Email: _________________________

Reason for Return:
_____________________________________________________________________________________
_____________________________________________________________________________________
___________________________________________

 

Operations Information (Administration fills out)

RA Number:_______________________ Date Received:________

Quantity Received:_________ Received By:_____ (initials)

Condition Received:

Excellent Good Fair Poor

Additional Comments:
_________________________________________________________________________________________
_________________________________________________________________________________________
___________________________________

Solution:

Credit Customer/Return to stock
Credit Customer/Debit Vendor