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2. Toner Cartridge Return Form - Empty or Defective
4. Date*
   Date
6. Department*
7. Contact Person*
9. Contact eMail Address:*
10. Contact Phone Number:*
12. Quantity *
13. Used or Defective - CHOOSE ONLY ONE*

    1. Used - Total Number Of ALL Returns
    2. Defective - Add information below about the defective unit **Complete a separate form for each defective cartridge.
15. Part Number of the Defective Toner Cartridge
16. Blue Book Number - If Applicable
18. Purchase Order Number - If Applicable**
19. County Depart. Office Supply Order Form - If Applicable**
21. ** IF DEFECTIVE, one of the two above fields must be completed. PLEASE ATTACH a copy of this form to the defective cartridge.
23. Defective - Describe the nature of the defect. Examples of reasons are: Cartridge damaged; Toner cartridge leaking; Prints lines; Loose toner in bag when un-boxing.
    Attach a print sample to the toner box if appropriate.
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field