Returned Merchandise Pick-Up Request Form

This form should only be used for Madison-area returns.

If this is your first time requesting a return, please review the information on our Return Policy page.

To ensure timely pick-up of your return, please do the following:

1. Write on a photocopy of your packing slip: the Return Authorization or Return Goods number and "RETURN TO MDS." Tape one copy of this label to the outside of each package.
2. Place the package(s) on your building's loading dock or wherever MDS leaves your deliveries.
3. Submit this form to arrange for your return to be picked up.

Please complete all information below (all fields are required for the form to be processed).

Prime Vendor (Staples, VWR, Grainger, Fisher, MDS Warehouse): Return Authorization Number (Staples, VWR, Grainger), Return Goods Number (Fisher), or Invoice Number (Shop@UW): Contact Person Name: Phone Number: E-mail: Department Name: Building Name and Street Address:
Shop@UW Account Number: Number of packages to be picked up: