EmailMeForm
Credit/Rebill Request
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Designates Required Field
The Ampersand Group Member Information
Requested By:
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Member ID
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Company Name
Email
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Phone
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Client Information
Client ID
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Client Name
First
Last
Item ID
Item Description:
Transaction Information
Original PO or RLS Number
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Original Invoice Number
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Reason for Credit:
Credit Information
Please credit my customer the following:
Total Credit Amount Requested (Tax Excluded)
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Apply Credit to:
Original Invoice
Leave on Account
Rebill Information
If you would like us to add an additional charge to the Rebilled Invoice please indicated instructions for Rebilling
Rebill New Item ID
Rebill New Item Sell
Rebill New Item Description:
How Do We Communicate Credit?
Sales Rep.
Mail Invoice
Email Invoice
Email invoice to:
Client
DO NOT Mail Invoice
Mail Invoice
Fax Invoice
Fax Invoice - Fax Number:
Credit Expected From Vendor
Vendor Name
Vendor Contact Name
Vendor Contact Phone Number
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Expected Credit Amount:
Notes:
Print
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