Return slip
RT-3315: what came back, the refund and the customer’s signature
Corner Store
301 Market Street, Portland, ME 04101
(207) 555-0100 · cornerstore.example
RETURN
RT-3315Oct 2, 2026 13:27
For receipt R-041146 · Sep 29
Market Street · Till 2 · Zoe Nair
1 Free-range eggs, 12−$4.75
Subtotal−$4.75
Tax$0.00
REFUND−$4.75
Visa Credit •••• 4242$4.75
Refunded to the card it was paid with
Reason: Duplicate charge
Back on the shelf: yes
Customer signature
This return
- Return
- RT-3315
- Original sale
- R-041146
- Item
- 1 × Free-range eggs, 12
- Refund
- $4.75 to card
- Processed by
- Zoe Nair
- Status
- Refunded
Two copies
The customer keeps one. The store keeps the signed one with the day’s paperwork: it is the proof the refund was asked for.