Return Request Form

Company Name:

Requested By

Telephone

E-mail Address

Order # / Picking Ticket #

Item Prefix
(3 Character manufacturer code)

Item #

Qty to be returned

Reason for return:
DefectiveOrdered too manyOrder entry error / wrong item orderedNot the item on the order / wrong item deliveredChanged mindDon't like the productOther

Please Explain

Input Captcha Code:

captcha