DATE RETURNED
CREDIT/REFUND
CREDIT/REFUND
FROM WHOM RETURNED
MANUFACTURER’S INVOICE PRICE
INTO STOCK
NUMBER
DATE
(NAME AND ADDRESS)
(BEFORE DISCOUNTS AND/OR DEALS)
0.00
Enter total from Form 4389, page 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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0
Enter total here and on Line 3 of Form 4387 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
4389 (02-2012)