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TION IIIII I I II II II I II III) III <br />Please complete and send back original with your return goods. W715164 <br />Please copy for your records <br />Please call 800-473-2138 if the <br />Holbrook, NY 11741-4306 wholesaler Intormatlon Iistea is DATE <br />1-800-473-2138 Customer Service incorrect. DO NOT change this form ZIA <br />GRX NO. // / <br />z/327 —/UG 3 <br />CUSTOMER' <br />I PHONE <br />t, <br />free e, / <br />Z 3 s -o d <br />C,t�Z- - / b <br />Call if wholesaler listed is incorrect. <br />Do not change wholesaler listed above. <br />DEA NO. <br />(% <br />BUYING GROUP <br />NUMBER OF BOXES <br />BEING'rSHIPPED# <br />WHOLESALER ACCT.# <br />(/ <br />OTY. MANUFACTURER DESCRIPTION <br />CITY. MANUFACTURER <br />DESCRIPTION <br />GROUND A.R.S. TRACKING NUMBER REF #/ DATE <br />UW 1Z 59W 098 06 1365 5964 <br />I <br />GROUND A.R.S. TRACKING NUMBER #/ DATE I <br />It�! <br />-REF <br />1Z 59W 098 06 1365 955 I <br />GROUND A.R.S. TRACKING NUMBER REF #/ DATE <br />1Z 59W 098 06 1365 5946 I <br />GROUND A.R.S. TRACKING NUMBER #/ DATE <br />1Z <br />1Z 59W 098 06 1365 5919 <br />GROUND A.R.S. TRACKING NUMBER I REF #/ DATE <br />1Z 59W 098 06 1365 5900 <br />GROUND A.R.S. TRACKING NUMBER I REF #/ DATE <br />1Z 59W 098 06 1365 5928 <br />APOW <br />AW AV AV <br />AW AW <br />E-MAIL ADDRESS: <br />AUTHORIZED SIGN TURE DATE SERVICE DATE <br />NEXT SERVICE DATE <br />FOR ADDITIONAL INVENTORY SPACE AND SHIPPING LABELS PLEASE PHOTOCOPY FORM AND BLUE LABELS <br />OR FORM AND LABELS ONLINE, WWW.GUARANEEDRETURNS.COM AND WWW.REVERSELINK.COM <br />ABOVETHE WHOLESALER LISTED ABOVE WILL RECEITE-TOII B (' REQII-117�, � ��F <br />-- •U MUST CALL 800-473-2138. <br />D• NOT USE THIS FORMYOU D• NOT USE THE WHOLESALERit <br />RETURN GOODS POLICY AND INSTRUCTIONSON <br />