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uaranteed <br />eturns <br />100 Colin Drive <br />0 <br />RETURN s S <br />Please complete and send back original with you., return goods. <br />Please copy for your records <br />Please call 800-473-2138 the I <br />Holbrook. NY 11741-4306 wncilesaler InTarinailon IIsIeu Is <br />1-800-473-2138 Customer service incorrect. DO NOT change this form> <br />DATE <br />GRX NO. <br />CUSTOMER <br />PHONE <br />. yr <br />5 ✓ C" <br />T-11 ,.+ (• k'�� `�' S � l 6 <br />Call if wholesaler listed is incorrect. <br />Do not change wholesaler listed above. <br />DEA NO. <br />BUYING GROUP <br />DAVID JOHNSON <br />NUMBER OF BOXES <br />BEING SHIPPEDO G/--. <br />WHOLESALER ACCT.# <br />1 — <br />cI <br />OTY. <br />MANUFACTURER <br />DESCRIPTION <br />QTY. <br />MANUFACTURER DESCRIPTION <br />® GROUND A.R.S. TRACKING NUMBER REF #/ DATE <br />UPS 1Z 59W 098 06 1193 8304 <br />f <br />) <br />A06 1194 0079 ,REF#IDATE <br />GROUND A.R.s.8KIN <br />UPS 1Z 59W GNUMBER <br />09 <br />#I DATE <br />® <br />UPS <br />REF <br />GROUND A.R.S. TRACKING NUMBER <br />1Z 59W 098 06 1194 0068 <br />fW <br />Aft <br />AM M <br />Sir R <br />Im —1 <br />NEW <br />il W <br />E-MAIL ADDRESS: <br />DATE <br />*FFORM <br />SERVICE DATE <br />NEXT SERVICE DATE <br />�NAL INVENTORY SPACE AND SHIPPING LABELS PLEASE PHOTOCOPY FORM AND BLUE LABELS <br />AND LABELS ONLINE, WWW.GUARANTEDRETURNS.COM AND WWW.REVERSELINK.COM <br />THE W�ibl-ESALER LISTED ABOVE WILL RECEIVE YOUR CREDIT—MEMOS. IF THE WHOLESAL <br />ABOVE IS INCORRECT YOU MUST CALL 800-473-2138. <br />DO NOT USE THIS FORM IF YOUDO NOT USE THEWHOLESALER <br />