RETURN RECEIPT	No	:
Date	:
Customer
[Company Name]	Name	:
[Company Address]	Address	:
[City, State, Zip Code]	City/State/Zip	:
[Phone][Email][Website]	Phone	:

Quantity	Description	Pieces per Package	Number of Packages
X __________________________________________________ Received By	Total Packages

RETURN RECEIPT	No	:
Date	:
Customer
[Company Name]	Name	:
[Company Address]	Address	:
[City, State, Zip Code]	City/State/Zip	:
[Phone][Email][Website]	Phone	:

Quantity	Description	Pieces per Package	Number of Packages
X __________________________________________________ Received By	Total Packages