Returned Goods Authorization 

  Date:                              

  Customer:                               Reason for Return:                             
  Address:                                                                                      
                                                                                                
  Contact:                                                                                      
  Telephone:                                                                                    



  PART/                                   QTY. TO BE    QTY. INSPECTED      
  MODEL #  DESCRIPTION                    RETURNED   RETURNED   PASS/FAIL      
      
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
                                                                            
  Comments:                                                                                                                                       
                                                                                                                                                       
                                                                                                                                                       
  Received by:                            Date:                              
   
                              Accounting Use Only
 
  Credit Memo to be issued:þ Yes  þ No$                                   
  Amount to be Refunded to Customer: $                                   
  Remarks:                                                                                                                                         
                                                                                                                                                       
                                       
                               Approvals        

                                                                                                         
  Sales/Service Manger                            DateCredit Manager                                    Date