Date: _____________

To: _________________ (Supplier)

We received goods from you pursuant to our order or contract dated ________, 19___.

We hereby reject said goods for the reason checked below:

__ Goods were not delivered within required time.

__ Goods were defective as described on reverse side.

__ Goods were non-conforming to sample or specifications as stated on reverse side.

__ Notice of acceptance of our order, as required, has not been received, and we ordered the goods from other sources.

__ Prices for said goods do not conform to quote, catalogue or order.

__ Goods represent only a partial shipment.

__ Other _______________________________________________ (describe).

Please issue appropriate credits or refunds if prepaid, and provide instruction for return at your expense. Rejection of said goods shall not be a waiver of any other claim we may have.

Very truly,

_______________________________