ENG H193 Company Store Return Form

Team Number:

Class Time:

Date:

Part Number

Part Description

Price/Unit

Quantity

x 0.75

Total

Total

Approved by

(instructor/GTA)

Date Returned

Returned By

(team)

Returned To

(store)

Date Credited

Credited by

(store)

Notes: Components from an Erector Set are not returnable.  Attach additional sheet(s) if needed.

Revision D, 04/28/04