Facilities Department - 419-755-4855 ~ Reference Purchasing Guidelines Procedure ~ Form 17-301 Last Revised 3-1-12
Damaged Items/Return Shipment Form 17-301a
THIS FORM MUST ACCOMPANY ALL RETURNS
Ship To: Addressee _______________________
Street _______________________
City _______________________
State/Zip _______________________
Attention _______________________
RMA # _______________________
Shipping Method US Mail UPS FED-EX
Item Description
__________________________________________________________________________________________
__________________________________________________________________________________________
Model ______________________ Serial # ___________________ NC State # ______________________
Date Received _____________ P.O. Number __________________ Item Value Returned $_______________
Return for Repair Return with PO Return without PO
Reason(s) For Return
__________________________________________________________________________________________
__________________________________________________________________________________________
________________________________________________________________________
Initiated By ________________________ Date __________ Department # __________ Phone __________
For Mail Room Only
Package ID # ___________________________ Parcel Weight ____________ Charges $__________
Pick-up Record # ___________________________________________ Pick-up Date _______________
Carrier ______________________________________________________________________________
SHIPPING OF PACKAGES
All packages must be accompanied by a Return Job Order.
Packages must be in Mail Room by noon to go out that day.
Inquiries to trace shipments should be addressed to Mail Room.
Returns Covered By Purchase Orders
1. All returns must be accompanied by a completed Return Job Order form.
2. Route all Return Job Order forms to Renee Nussbaum.
3. All packages should be sent to Receiving. Include a copy of the Return Job Order form.
4. If a Return Job Order form is not completed, merchandise and form will be returned to originator for completion.
Packages - No Purchase Order
1. A Return Job Order form must be filled out and attached to package. Form will be returned to originator if not filled out.
2. Route to Mail Room for processing - if packaged.
3. Route to Receiving - if packaging is required. Receiving will forward to Mail Room for processing.
4. Include mailing label.
Repairs
1. All repairs must be accompanied by a completed a Return Job Order form which includes serial number and/or inventory number
and the reason for repair.
2. Route all Return Job Order forms to Renee Nussbaum.
3. All packages should be sent to Receiving. Include a copy of the Return Job Order form.
4. If a Return Job Order form is not completed, merchandise and form will be returned to originator for completion.
