Machine Sales Return Order Form

CUSTOMER DETAILS:

Customer / Trading Name: *

Account Number: *

Collection address: *

Street address *Street address line 2

City *

State *

Postcode *

Machine order type: *

Credit to apply? Is yes, how much?

Is this a repair return? *

How many different Item #'s do you require to be returned? *

123

Quantity: *

Item # to be returned: *

Item description: *

Serial #: *

Quantity

Item # to be returned:

Item description:

Serial #:

Quantity:

Item # to be returned:

Item description:

Serial #:

Reason for return: *

Replacement machine order (Y/N): *

YesNo

Has the machine order form (MOF) been completed? *

YesNo

Standard return fee applicable (Y/N): *

YesNo

Termination costs applicable: *

YesNo

Client site contact: *

Client site phone: *

Client site email: *

Date requesting collection: *

Omni representative (requested by): *

Omni rep email *

**For cancelled contract returns, termination fees may apply. These fees will be calculated by Susie Risbey prior to a Sales Return Order is created & Approved to collect**