ARKANSAS TECH UNIVERSITY REQUEST TO RETURN MERCHANDISE
(Department Name) Date: ____________________________
Russellville, AR 72801-2222
Tel: 479-___-______
Fax: 479-___-______
To: ATU PURCHASING DEPARTMENT
Please provide the following information and attach a copy of the Packing Slip and/or
Invoice. Purchasing will request authorization to return the merchandise.
Keep the item(s) in a secure location. If the merchandise was damaged in transit or is
defective, KEEP THE ORIGINAL BOX AND/OR PACKING MATERIALS.
Vendor: __________________________________________________________
Telephone No: ______________________ Fax No: ________________________
Date Order Placed: __________________ Date Order Received: _____________
Item Number & Description: ______________________________________________
Quantity: ____________ Unit Price: $____________ Total: $______________
CHECK THE APPROPRIATE BOX:
REASON FOR RETURN EXPLANATION
Damaged
Defective
Wrong Item
Duplicate Shipment
Did Not Order
Other
Cardholder: ______________________________________ Last 4 Digits: ________
Cardholder’s Signature: __________________________________________________
Signature of Immediate Supervisor: ________________________________________
