Return/Rejection/Damage Report
Attention Receiving & Quality Control Departments: In case of damaged or rejected shipments, this report is meant to be a quick and easy way to report these incidents and to enable us to react to the situation in a more timely manner. All fields of this form must be completed. Thank you for your cooperation.
Customer Information
Name
*
First Name
Last Name
Company Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Fax Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Product Information
Date Received
*
-
Month
-
Day
Year
Date
Quantity Recieved
*
Trucking Line
*
Packing Slip Number
*
Part ID
*
Please type as shown on the packing slip.
Lot Number
*
See image below for information.
P.O Number
*
Describe the problem.
*
Do you want to return the product?
*
Yes
No
Submit
Should be Empty: