Account Manager/First & Last name
*
Date
-
Month
-
Day
Year
Date E-Claim is Submitted
PURCHASERS NAME
*
FIRST & LAST NAME
ORDER NUMBER
*
Phone Number
*
Please enter a valid phone number.
Email
*
Please enter a valid email address.
Date Material was Received
*
-
Month
-
Day
Year
Date
PRODUCT DISCOUNTED
*
If product was discounted, what was the discount on product.
LOCATION OF MATERIAL
*
WAREHOUSE
JOBSITE
Other
INSTALLED
*
Yes, it was Installed
No, it was not Installed
Other
LINE #'S
*
Please only put line # of item and how much material is being returned.
CLAIM DUE TO?
*
Damage
Sample Mislabeled
Return/Overage
In-Stock
Inspection/Jobsite visit
Lost in transit
Rusty
Vendor Shipped Wrong Material/Color
Over 30 day return window
Exception approved by GM
Sales Error
Other
DO WE NEED TO PLACE MATERIAL ON ORDER/REORDER?
ESTIMATE # IF REORDER
If over 30 day return window/exception by GM. Must provide emailed approval if not applicable please put N/A.
*
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AM EMAIL
*
example@example.com
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