Date (mm/dd/yy):
Account Information (please complete applicable fields):
Company Name:
Serial Number or Sales Order Number (required):
Contract Number (required):
Budget Center (required):
Shipper (Origin) / Pickup Information:
Contact Name:
Email Address:
Phone Number:
Street:
City, State, Zip Code:
Room / Pickup Location:
Pickup Location Times:
Special Shipping / Pickup Instructions:
Reason for Return:
Good / Unused:
yes no
For used supplies: www.xerox.com/gwa
for recycling information
Damaged / Defective:
yes no
Reason for Return (no longer have device, wrong shipment, excess, etc.):
Additional Comments / Special Instructions:
Instructions
1.
Please complete all sections.
2.
Follow shipping instructions below.
3.
4.
Please email this completed form to:
Can.GDC.SARG.Group@xerox.com In
subject line of your email please include:
Company Name: Supply Return
5.
You will receive an e-mail or phone call with a Return Material
Authorization number (RMA) and further shipping instructions.
6.
Please allow up to 3 weeks for pick up. Please reply to your
confirmation e-mail for inquiries.
Shipping Instructions
Returns under 200lbs:
Consolidatemultipleitemsintolargerbox(es).
643N parts need to be bundled sperately!
Maximumweightofeachboxis70lbs.
Maximumnumberofboxesis13.
Labelthebox(es)withtheReturnMaterialAuthorization(RMA)
numberprovidedbytheXeroxCallCenter.
PleasedonotwritedirectlyonXeroxoriginalpackaging.
Returns exceeding 200lbs:
Consolidatemultipleitemsontoapalletandshrink-wrap.
LabelallpalletswithBillofLading(BOL)providedbyCarrier.
Haveacopyavailableatpick-up
LabelthepalletwiththeReturnMaterialAuthorization(RMA)
numberprovidedbytheXeroxCallCenter.
PleasedonotwritedirectlyonXeroxoriginalpackaging.
Suppliesshouldremaininoriginalpackaginguntilused.Boxes
shouldbemaintainedinoriginalor“likenew”conditiontoallow
restocking.
Xerox Unused Supplies*
Return Form
*ThisreturnprocessappliestoentitledsuppliescoveredunderaXeroxContract.Itcannotbeusedtoreturnbillable
supplies.Forusedsuppliesrecycling,pleasevisitwww.xerox.com/gwa
7125254-001
Xerox Unused Supplies
Return Form
©2012XeroxCorporation.Allrightsreserved.Xerox®,XeroxandDesign®aretrademarksofXeroxCorporationin
theUnitedStatesand/orothercountries.BR4077SUPUU-01UA
Reorder # Carton Quantity
Total Cartons:
Total Boxes or Pallets:
0
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