Notification Form Complaint Processing 1-877-275-6323 Merchant Claim # Printer Claim # Merchant Name Printer Name Contact Name Contact Name Contact Phone Contact Phone Merchant Buyer Mill Information NewPage Invoice # Run or Roll # Grade Description Size BS Weight Cover Text Color PO or Order# Claim Information Quantity Rejected Forms Rejected For Carbonless Only Plies or Parts 1  2  3   4   5  6 Check One Rolls Cartons Skids Samples Submitted Type Yes No Tape Pulls Printed Sample Unprinted Sample Photographs Film Positive Label Check One Rolls Cartons Skids Pressroom Information Press Type Ink Type Ink Sequence Fountain PH Pressroom RH Zone 1 Zone 2 Zone 3 Zone 4 Oven Temperature Coated Web Only Nature of Claim (In Detail) Debit Information Please breakdown all presstime charges. The presstime charges must be accompanied by printer's memo showing all the charges. Please attach the information to this claim form. Press Charges Hours Rate Per Hour Total Makeready Run Time Wash Up Other (Explain) Paper Charges Quantity Cost - CWT Printed Stock Unprinted Stock Other Paper Charges Location of Rejected Stock Debit Memo Number Grand Total