date： _
to： _ [supplier]
we received goods from you pursuant to our order or contract dated _， 19_.
we hereby reject said goods for the reason[s] checked below：
__ goods were not delivered within required time.
__ goods were defective as described on reverse side.
__ goods were non-conforming to sample or specifications as stated on reverse side.
__ notice of acceptance of our order， as required， has not been received， and we ordered the goods from other sources.
__ prices for said goods do not conform to quote，catalogue or order.
__ goods represent only a partial shipment.
__ other [describe] _
please issue appropriate credits or refunds if prepaid，and provide instruction for return at your expense. rejection of said goods shall not be a waiver of any other claim we may have.
very truly，
_______________________________