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Return Information

This form is to be printed, filled out, and sent with returned or exchanged product.To print this form, select File->Print in your Web Browser, or Ctrl-p (PC) or Command-p (Mac) from your keyboard.

Was this a ___ phone, ___ email, or ___ internet order?

If an internet order, what is the order number? ____________

If a phone or email order,
what date was the order made? _____________________

Ship to name as it appears on the order: _________________

Ship to address: _____________________________________

___________________________________________________

City: ______________State/Country: _____  Zip: _____

Daytime Phone Number: _________________

Email Address: _________________________

Name as it appears on your credit card: _________________

Credit Card Number: ___________________ Exp Date: _____

Is this a return or an exchange? _______________________

Please explain the reason for the refund or exchange:

_______________________________________________

_______________________________________________

Office Use Only:
Product:
Cost:
Other:
Total Refund: