RGA Credit Rebill Form - Brenntag Lubricants Northeast

Brenntag Lubricants Northeast / RGA Credit Rebill Form

RGA Credit Rebill Form

Transaction Request*
Who is Responsible for the Error?*
Order Entered By:*
Date*
Date Format: MM slash DD slash YYYY
Account #*
Ship To Location #*
Account Name*
Address
Street Address City State ZIP Code
Delivering Facility*
Sales Rep Assigned*
Invoice/Order Request is Concerning*
*
Product Part # Quantity Price
Total Credit Request Amount*
Date of Sale*
Date Format: MM slash DD slash YYYY
Reason for Credit/Rebill | RGA?*
Comments
Form Filler's Email*
Sales Rep*
RSM*
Sales Support Rep