REQUEST FOR AUTHORIZATION TO RETURN MERCHANDISE

General Information

Date:

*required fields

*School District/Agency:    

*School Code/Name:  

*Contact Name:    

*Phone:   

*e-mail Address: 

Reference Information

*Choose One Reference:  KCDA Order Supply Link Cart   Number: Dated: 

P.O. Number

Product Information

Reason: Damaged ; Defective; Over Ship; Customer Ordering Error;                 Shipping Error

Explain:

*Number of Cartons Returning to KCDA 

Replacement? Yes ; No