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Wells Engineered Products
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RETURN GOODS REQUEST (RGR)
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Customer
*
End Customer
Contact
*
Purchase Order #
Phone
*
Date
*
Email
*
Address
*
WellsVE Part #
Customer Part #
*
Date Code or Identification
*
Qty. of Parts to be Returned
*
Time to Failure
0-km
Field
Miles
Hours
Application (Check One)
Motorcycle
Agriculture
Off-road
Automotive/Light Duty
Heavy Duty/Commercial
Stationary Power
Marine
Other
Was the Failure Verified?
Yes
No
Gas or Diesel?
Gas
Diesel
Failure Description (i.e. operating conditions, temperature, dependence, details of diagnostics)
Comment
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Wells Engineered Products
385 W. Rolling Meadows Drive
Fond du Lac, WI 54937
(920) 922-5900
Contact:
info@wellsengineeredproducts.com
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