Customer# Invoice# Part Number Returned Qty (pcs) Description DH Casters, Inc
2260 S Haven Ave, Ste C
Ontario, CA 91761
808.543.3413 Acknowledgement of Scrap Credit for the parts listed below will be issued upon the return of this signed Acknowledgement at the invoiced price. By signing this acknowledgement you are confirming that the below listed parts have been or will be scrapped as per your company's scrap procedure. The scrap procedure will ensure that these parts are void of use. DH Casters will not be liable for the following scrap product: Print Name Signature Title Date