Manufacturer Return Authorization Form

 

Warehouse/DC Pickup (Category 2)

Please Note: Fields marked with (*) are required fields.

 

 

Manufacturer Contact Information  
* Name: * Email Address:
* Telephone#: Fax:
       


Pickup Location Information
 

* Warehouse/DC Name: Manager's Name:
Warehouse/DC Number: *(Manu) RA# or RIN#
Customer RA#   * Customer Address:
* City: * State:
* Zip Code: * Customer Phone Number:
       
  
 
  Product Name   Case Code   Quantity (Cases)   Code Date

 

 
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