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Series 704.3.5.2P - Return Merchandise Request

Adopted: July 1993
Revised: May 2013

INSTRUCTIONS
1. This form will be used to initiate the return of merchandise to the supplier.
2. All returns will be handled through Central Receiving.
3. Retain a copy for your records and forward the original, with the merchandise being returned, to Central Receiving.
4. This form must be completed by the school or department initiating the return. Central Receiving will NOT
accept or process incomplete Return Merchandise Request forms.

School/Department: _________________________________________________ Date: ________________________
Person Submitting: __________________________________________________ Phone: _______________________
P.O. # __________________________ or, Name on P-Card: ______________________________________________
Ship to: (PO Box addresses are not acceptable)
__________________________________________________________
__________________________________________________________
__________________________________________________________
Supplier's phone: ___________________________________________
Reason for return: _________________________________________________________________________________
 

Quantity     Description                                                Item #                   Unit Price          Total Cost
_________ _________________________________________ ________________ _ ____________ _____________
_________ _________________________________________ ________________ _ ____________ _____________
_________ _________________________________________ ________________ _ ____________ _____________
_________ _________________________________________ ________________ _ ____________ _____________

Complete the following steps:
________ I have contacted the supplier to arrange for this return on (date): ___________________________________
________ This return was authorized by (supplier contact): _______________________________________________
________ This return requires a return authorization #: ___________________________________________________
________ I have asked the supplier to send a pre-paid return label: YES/NO Carrier: ___________________________
________ Special instructions for this return: ___________________________________________________________
If the original order was purchased with a purchase order please complete the following:
________ I have made purchase order remarks in the finance system indicating the date of the return and if applicable
the PO number for the replacements.
________ I have created the following purchase order for the replacements: P.O. #____________________________

For Central Receiving use only:
Returned via: _ _________________ Shipping charges: ___________________ Waybill #: ______________________
Number of packages: ____________ By: _______________________________ Date: _ ________________________

Procedures/704.3.5.2P/5-28-13