REQUEST
TO RETURN PART
DATE: ____________________________________
FROM: __________________________________________
(name)
__________________________________________
(facility name)
__________________________________________
(Phone)
TO: __________________________________________
(name)
__________________________________________
(facility name)
On _____ / ______ / ______
(date) we purchased the following part(s) from you with
YEAR MODEL PART/IC#/OEM# COST
_________ _____________________________ ________________________________________ $__________
_________ _____________________________ ________________________________________ $__________
_________ _____________________________ ________________________________________ $__________
_________ _____________________________ ________________________________________ $__________
Tax $__________
Shipping/Handling $__________
Total $__________
We would like to request
credit from you without the return of the part(s) shown above to you for the
following reason(s):
¨ Part damaged on arrival ¨ Not
the correct part
¨ Mechanical failure ¨ Additional parts needed
(see below)
¨ Replacement parts needed
(see below)
The amount of credit requested is
$_______________. Additional
documentation (as needed) is included with this fax. Once approved, please fax a credit invoice to
______-______-_____________
Additional or Replacement Parts needed:
SELLER’S
AUTHORIZATION
Your request to return the parts shown above is ¨ approved ¨ denied.
Once the part arrives at our facility we will fax a
credit invoice in the amount of $__________
________________________________
(print
name)
___________________________________(sign)
_____________ (date)