Return Authorization Request Form

Returns Authorization Request Form

Individual Initiating Return*

First NameLast Name
Company Name*
Auburn Account Number*
Please enter your Auburn Pharmaceutical Account Number here.
Customer Email*
Customer Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Customer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please fill in all of the information related to your return.*

Rows	NDC or Item No.	Product Description	Size	Invoice #	Invoice Date	Lot #	Price Paid Per Unit	# of Bottles/Tubes/Boxes being returned	Reason for Return	AUBURN INTERNAL
Item #1
Item #2
Item #3
Item #4
Item #5

Item 1

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
DSCSA Serialization Return Requirments

As part of federal Drug Supply Chain Security Act (DSCSA) requirements, we are now required to collect the product serial number for each saleable unit being returned.

This information helps ensure full product traceability and allows us to process your return as quickly as possible.

When submitting this return request, please provide the serial number(s) for all items included in your return using one of the options below.

If you are returning a single unit, you may either upload an image of the product barcode or manually enter the serial number. If you are returning multiple units, you may upload a file containing barcode images for each item or a file listing the serial numbers for each unit being returned.

Returns that do not include the required serial number information may be delayed or unable to be processed.
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 2

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 3

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 4

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 5

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 6

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 7

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 8

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 9

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof
Would you like to return another item?*

YesNo

Item 10

Please complete all of the below information. Incomplete or inaccurate information may result in the denial of your return request.
Item Number*
NDC*
Generic Product Name *
Size (60 ct., 100 ct., etc.)*
Invoice Number*
Invoice Date*

MonthDayYear
Date
Lot #*
Product Expiration Date*

MonthDayYear
Use "01" as the date value for those bottles with only month and year listed. E.g., 03/01/2026 for a bottle dated 03/2026.
Price Paid per Unit*
Number of Bottles/Tubes/Boxes etc. Returned*
Reason for Return*
Please use this space to provide any additional information and/or comments:*
How will you provide product serialization information?*

Upload barcode image (single unit): Select this option if you are returning one item and will upload a clear photo or scan of the product barcode showing the serial number.Upload barcode images (multiple units): Select this option if you are returning more than one item and will upload a file containing barcode images for each unit included in the return.Manually enter serial number (single unit): Select this option if you are returning one item and will type the serial number exactly as it appears on the product barcode.Upload file with serial numbers (multiple units): Select this option if you are returning more than one item and will upload a document (such as Excel or PDF) listing the serial number for each unit included in the return.
Product Serial Number (Single Unit) *
File Upload (Single Barcode Image | File Containing Multiple Barcode Images | File Containing Multiple Serial Numbers)*

Cancelof

I acknowledge that the product(s) being returned was purchased from Auburn Pharmaceutical and that the product(s) was(were) stored under appropriate conditions of temperature, humidity, and light. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated here are true.
Signature of Individual Initiating Return*
Should be Empty:

Returns Authorization Request Form

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