List, out what items are being returned and what actions should be taken by the vendor.

Printed on 3 part carbonless (white, yellow & pink) paper in your choice of Red, Ivy Mint Green, Amazon Green, Brilliant Blue, Reflex Blue, Black or Burgundy ink. Your company name, address and phone number imprinted at no additional charge.

Size 8 1/2 X 7. Consecutive numbering starts onall numbered forms at 101 unless otherwise specified. (Please indicate in space provided below).

Also available in 2 part carbonless. See product number 5272.