Goods Receiving Form

Received from : S&R Membership Shopping

Address: Dau Mabalacat Pampangga

Purchased Order Number of Returned Freight Bill # Date

Goods

-- 1-875365192A 01- 04 -22

Shipping Via Prepaid (Details) Collect (Details)

Delivered Prepaid ( Credit card) --

Quantity Item reference # Description

1. 15 1-435C Canned Goods

Date: 01-05-2210
2. 2-876D
NOTICE: RETURN OFGOODS Packed noddles

3. 20 3-087F Cooking ingredients

4. 20 4-754B Perishable Goods ( Meat )

5. 3 5-654N Imported wine

6
Remarks:

Wet and destroyed cardboard box

# of packages Total weight Received by Checked by Delivered to

5 Packages 155 lbs Shaira Grospe Shaira Grospe Armando

Grospe
TO: FROM:

S&R Membership Shopping Armando Grospe

Dau Mabalacat Pampangga Mabilog Concepcion Tarlac

We are submitting this notice to verify our rejection of the following order:

CONTRACT DATE P.O # INVOICE #

 -- 546798120E 67098214
DELIVERY DATE PACKING SLIP # BILL OF LADING #

01-04-22 4 806535 179152 1-253689013O

We are hereby RETURNING the above goods on account of defects in the goods stated as follows.

REF # QTY ITEM DAMAGE PRICE CREDIT DUE

DESCRIPTION DESCRIPTION

65370 1 Imported Broken 850 850

wine
09012 5 Packed Package Torn 50 250
Noddles
Canned
56391 5 Goods With Dents 30 150
TOTAL CREDIT DUE: 1,250

Credits for the goods returned is hereby claimed and demanded. Such a claim does not limit our rights
to further credits or damages if additional credits or damages are discovered to be due or additional
return are made. Settle release with or release to you does not waive any rights against any other party.
All rights are cumulatively and exclusively. Nothing contained herein shall alter an other documentation
issued by us unless specifically stated so.

RETURNING PARTY

By: Armando Grospe

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