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Instruction: Please print or type, fill in all spaces and complete by “Submitting” where indicated. Submission is mandatory prior to receiving credit terms. If a corporation, the signature must be that of an officer or authorized agent. All information will be kept confidential.

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Return Application

Customer Name:
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Return #1:

 
Invoice Number:
Customer P.O. Number:
Quantity:
Part Number:
Description:
Unit Price:
Reason for Return:


Return #2:

 
Invoice Number:
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Return #3:

 
Invoice Number:
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