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* Required Fields
Date Received:
Company Name:
Email:
Name:
Contact:
Phone:
Fax:
Rep:
Invoice:
(All actions apply only to entries with check marked check boxes only.)
Code: Incorrect Order:Item(s) received is not what was originally ordered. DAMAGED:Item(s)received was damaged or broken Quality: Item(s) received does not meet quality expected or shown Defective:Item(s) received has a manufacturing defect SHORTAGE/ITEM MISSING DUPLICATE CHARGE/OVERCHARGE OTHER
Qty:
ITEM#:
Description:
COST/EXT:
What to do with item: REPLACE CREDIT REFUND