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REPORT OF DUPLCATE/INCORRECT/DAMAGED GOODS RECEIVED TO BE COMPLETED BY DEPARTMENT VENDOR NAME ADDRESS CITY STATE ZIP CONTACT NAME PHONE NUMBER INVOICE NUMBER DATE PURCHASE ORDER NUMBER CREDIT CARD PURCHASE YES NO REASON FOR FILING REPORT RECEIVING DEPARTMENT WISHES TO REJECT REPLACE AUTHORIZATION TO RETURN GOODS SHIP TO NAME RETURN GOODS AUTHORIZATION NUMBER IF APPLICABLE Print name Signature DEPARTMENT RETURN COMPLETED FORM TO PURCHASING ACCEPT.

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