Fillable INVOICE/MANIFEST ACTUAL DATE AND STATE LICENSE # AM (California)

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INVOICE/MANIFEST ACTUAL DATE AND STATE LICENSE # AM (California)

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Country of origin: US
File type: PDF

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SALES INVOICE/ SHIPPING MANIFEST
PLEASE USE PERMANENT INK FOR ALL ITEMS
INVOICE/MANIFEST
NUMBER:
ATTACHED PAGE(S)?
YES NO
# OF ATTACHED
PAGES:
ACTUAL DATE AND
TIME OF DEPARTURE:
/ /
AM
PM
ESTIMATED DATE AND
TIME OF ARRIVAL:
/ /
AM
PM
SHIPPER INFORMATION
STATE LICENSE #
TYPE OF LICENSE
BUSINESS NAME
BUSINESS ADDRESS
CITY, STATE, ZIP CODE
PHONE NUMBER
CONTACT NAME
RECEIVER INFORMATION
STATE LICENSE #
TYPE OF LICENSE
BUSINESS NAME
DELIVERY ADDRESS
CITY, STATE, ZIP CODE
PHONE NUMBER
CONTACT NAME
DISTRIBUTOR INFORMATION
STATE LICENSE # DRIVER’S NAME
BUSINESS NAME
CA DRIVER’S LICENSE#
STREET ADDRESS
VEHICLE MAKE
CITY, STATE, ZIP
VEHICLE MODEL
PHONE NUMBER
VEHICLE LIC. PLATE #
CONTACT NAME
ACTUAL DATE AND
TIME OF ARRIVAL
/ /
AM
PM
PRODUCT SHIPPED DETAILS
SHIPPER COMPLETES ALL THE UNSHADED COLUMNS BELOW. RECEIVER COMPLETES ONLY THE SHADED COLUMNS BELOW
(Please attach additional pages, if needed)
UID TAG NUMBER
(IF APPLICABLE)
ITEM NAME AND
PRODUCT DESCRIPTION
(INCLUDE WEIGHT OR COUNT)
QTY
ORDERED
QTY
REC’D
UNIT
COST
TOTAL
COST
RETAIL ONLY
UNIT
RETAIL
VALUE
TOTAL RETAIL
VALUE
PRODUCT REJECTION
IF PRODUCTS ARE REJECTED, PLEASE CIRCLE THE ITEMS BEING REJECTED IN THE PRODUCT SHIPPED DETAILS SECTION ABOVE
REASON FOR REJECTION:
PRODUCT RECEIPT CONFIRMATION
I CONFIRM THAT THE CONTENTS OF THIS SHIPMENT MATCH IN WEIGHT AND COUNT AS INDICATED ABOVE.
I AGREE TO TAKE CUSTODY OF ALL ITEMS AS INDICATED RECEIVED ABOVE – AND WHICH ARE NOT CIRCLED.
THE PRODUCTS CIRCLED ABOVE ARE REJECTED FOR DELIVERY AND REMAIN IN THE CUSTODY OF THE DISTRIBUTOR FOR RETURN TO THE
SHIPPER AS INDICATED ON THIS FORM AND ALL ATTACHED PRODUCT DETAILS SHEET(S).
NAME OF PERSON RECEIVING
AND/OR REJECTING PRODUCT:
PHONE
NUMBER:
SIGNATURE OF PERSON RECEIVING
AND/OR REJECTING PRODUCT:
DATE
SIGNED:
SALES INVOICE / SHIPPING MANIFEST
PRODUCT DETAILS ATTACHMENT PAGE
PLEASE USE PERMANENT INK FOR ALL ITEMS
INVOICE/MANIFEST NUMBER
ATTACHED TO:
ATTACHED PAGE OF TOTAL PAGES
PRODUCT SHIPPED DETAILS
SHIPPER COMPLETES ALL THE UNSHADED COLUMNS BELOW. RECEIVER COMPLETES ONLY THE SHADED COLUMNS BELOW
(Please attach additional pages, if needed)
UID TAG NUMBER
(IF APPLICABLE)
ITEM NAME AND
PRODUCT DESCRIPTION
QTY
ORDERED
(Weight or
Count)
QTY
REC’D
(Weight
or Count)
UNIT
COST
TOTAL
COST
RETAIL ONLY
UNIT
RETAIL
VALUE
TOTAL
RETAIL
VALUE
PRODUCT REJECTION
IF A PRODUCT(S) ARE REJECTED, PLEASE CIRCLE THE ITEMS BEING REJECTED IN THE PRODUCT SHIPPED DETAILS SECTION ABOVE
REASON FOR REJECTION:
PRODUCT RECEIPT CONFIRMATION
I CONFIRM THAT THE CONTENTS OF THIS SHIPMENT MATCH IN WEIGHT AND COUNT AS INDICATED ABOVE.
I AGREE TO TAKE CUSTODY OF ALL ITEMS AS INDICATED RECEIVED ABOVE – AND WHICH ARE NOT CIRCLED.
THE PRODUCTS CIRCLED ABOVE ARE REJECTED FOR DELIVERY AND REMAIN IN THE CUSTODY OF THE DISTRIBUTOR FOR RETURN TO THE
SHIPPER AS INDICATED ON THIS FORM.
THIS PRODUCT DETAILS ATTACHMENT PAGE IS ATTACHED TO INVOICE #
NAME OF PERSON RECEIVING AND/OR
PHONE
REJECTING PRODUCT:
NUMBER:
SIGNATURE OF PERSON RECEIVING
DATE
AND/OR REJECTING PRODUCT:
SIGNED:
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INVOICEMANIFEST ACTUAL DATE AND STATE LICENSE AM (California)

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Completed 20 March 2021

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