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Return Authorization Request Sheet
Request Date*
Sales Person* Sales Team  
Customer Name*
P/U Address*
Suite or Room
City, State, Zip*


Primary Contact Name
Name *
Phone Number *
Email *

Alternate Contact
Name *
Phone Number *
Email *


Form Submitted By:
Name *
Phone
Number
Email


Additional Names & Email Addresses to CC: This Return Authorization
Name Email


Customer PO# *
System Source Invoice Number *

Please submit separate Return Requests for each System Source invoice number

Products to Return
Item 1
Stock # * Quantity * Description *
Product Packaging * Reason For Return * DOA Problem Description *
Item 2
Stock # Quantity Description
Product Packaging Reason For Return DOA Problem Description
Item 3
Stock # Quantity Description
Product Packaging Reason For Return DOA Problem Description
Item 4
Stock # Quantity Description
Product Packaging Reason For Return DOA Problem Description
Item 5
Stock # Quantity Description
Product Packaging Reason For Return DOA Problem Description
Additional Return Comments


For Pickup Locations Outside of the
Baltimore, Maryland-Washington, DC Area Only:
Number of Boxes for Pickup
Weight of Each Box for Pickup(estimated)

 
* Indicates required field
If you have any problems with this form, contact System Source

 
338 Clubhouse Rd Hunt Valley MD 21031 • 410.771.5544 • f. 410.771.9507
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