CRS Discrepancy Shipping Form.doc

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					                      SUNY DOWNSTATE MEDICAL CENTER
                      CENTRAL RECEIVING & STORES

                      *SHIPMENT DISCREPANCY REPORT: Complete Sections A, B. If a return to vendor is necessary, also
                      complete sections C&D. Use separate form for each separate PO #.
                      *OUTBOUND SHIPPING AUTHORIZATION: Complete Sections A,C,&D.
Instructions:
Electronic: Complete the form, then “Save As” -change document name to a unique name. Then attach new document & e-mail to centralreceiving@downstate.edu
Manual: Print Off, complete the form manually, then fax to CReceiving & Stores at Ext 1266, or bring to CReceiving & Stores at UH Room ALL1-530.
_______________________________________________________________________________________
SECTION A - Customer Information                                                                                   Today’s Date:______________

______________________                    _____________ __________________                    __________           __________
Your Name                                 Title         Dept                                  TeleExt              Box#
_______________________________________________________________________________________
SECTION B: Discrepancy Report on a Shipment

Purchase Order # _______________________ Date Item was Delivered to your Dept: _______________________

Nature of Discrepancy (Mark one):
____ Shipment never received                                                                ____ Price Change resulting from vendor substitution
____ Item(s) Received Damaged or Broken                                                     ____ Overshipment or Duplicate Shipment
____ Unacceptable vendor item substitution                                                  ____ PO Cancelled
____ Quantity Discrepancy (Packing Slip vs. actual contents)

Describe item and problem (be specific):


Did you contact the Vendor? __NO __YES. If yes, give name & phone # of person contacted: ___________________________________
                                                                                                                   (Insert Name & Tele#)
Does Item(s) need to be returned to vendor? ___NO ___YES -If Yes & need CR pick-up at:____________________________________
                                                                                                                   (Insert Bldg /Room)
SECTION C - All Other Outbound Shipments - Reason For Shipment (mark one):
_____ To Resolve Discrepancy reported in section B above.
_____ For Repair or Replacement -insert PO # or requisition # for repair: _______________________
_____ Other (specify):



SECTION D - METHOD & PAYMENT OF SHIPPING CHARGES: (mark one):
___ Least Costly                                         ____ Overnight Required
___ UPS                                                  ____ 2 Day Required
___ Vendor’s Trucking (Common Carrier)
___ Other (specify):



If Shipping Insurance is required, insert insured value: $ ___________

Method of payment for shipping cost:
___ Vendor (Addressee must authorize Pickup): PREPAID Shipping Label Provided by Vendor on Package
        Has vendor contacted the pick-up by courier? NO YES
        Did Vendor Authorize the Payment? NO YES Vendor’s Return Authorization # ___________________
____ DMC Dept –Insert funding source/acct#:___________________ (State accounts are recharged to CStores Recharge Object Code 9200)

THIS SECTION FOR CENTRAL RECEIVING & STORES USE ONLY:
For State PO’s Affecting Price or Qty Discrepancies: ______E -Mail/ Faxed To Accounts Payable (X-3375)
                                                     ______E -Mail/ Faxed To Purchasing (X-4413)
SURS RECEIPT # (IF APPLICABLE):__ ________________________________
SURS Adjustment Receipt #___________________________________________
RECEIVING RETURN # ___________
COURIER PICKUP RECORD # ______________________________CR&S Staff Intials: _____________Date ________