Power Line Supply

Power Line Supply 420 Roth Street Reed City MI 49677 Phone 1-800-832-2297 Fax 231-832-2490 TEST LABORATORY RETURN FORM SHIP TO:_________________________ BILL TO: ________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ PURCHASE ORDER #:__________________________________________ OTHER INSTRUCTIONS:________________________________________________ ______________________________________________________________________ ______________________________________________________________________ GLOVES, SLEEVES, OR BLANKETS NUMBERED___________ REJECTED MATERIAL REPLACED________________ REJECTS TO BE RETURNED _____________ GLOVES POWDERED_____________ RETURN METHOD _________________ CONTACT NAME:______________________ PHONE:________________________ EMAIL:_________________________ DATE OF SHIPMENT:_______________ NUMBER OF BOXES SHIPPED_____________ RETURN OF TESTED MATERIAL REQUIREMENT DATE_________________ PROTECTIVE EQUIPMENT