ACDelco Return Parts Application (PC355)
Please check your Administrative PDC
Memphis PDC 92
Six Digit
ACDelco Account
Number
(ACDelco Distributor Account Name)
(Address)
(City, State and Zip Code)

Reason For Return
Check the box indicating reason for
return. Do not check more than one
box per return application
Semi-Annual Return (01)
Termination Return (02)
Improperly Boxed (03)
Concealed Damage (06)
New Defective (07)
Special Product Returns (12)
Duplicate Order – Customer Input (19)
Invoice Number
Invoice Date
Supersession Return (21)
Semi-Annual Return Spoils (25)*
Other

Customer Control
Number
MAXIMUM 5 NUMERIC DIGITS

Quantity

Part Number
(Use Original – Not Superseding No.)

Please check if computer generated listing of
parts to be returned is attached and properly
identified (see instructions on reverse side of
form).
Comment

Page:
Date:

1

of 1

Instructions - By Return Type

APPLICATION REQUIRED FOR
ALL RETURN TYPES

Return Types 01, 02, 19, 21 and 25:
1. Prepare original PC355
2. Mail original to regional sales office for
approval
3. When approved, regional sales office
will mail original to PDC
4. No returns are to be made prior to
receiving the Material Return
Authorization Document and
material return tags from the PDC
Return Types 03, 06, 07 and 12:
1. Prepare original PC355
2.. Send original PC355 to your
Administrative PDC for processing
3. PDC will mail Material Return
Authorization Document and material
return tags
4. No returns are to be made prior to
receiving the Material Return
Authorization Document and
material return tags from the PDC

Price Each

Extension

Page Total
Grand Total

For ACDelco Regional Sales Office Use – Approval Required on Return Types 01, 02, 19, 21 and 25
Approved By:

Region:

Date:

___________________

PC355 Rev. 06/12