Return Form

Return & Exchange Form (Rev 2.0-9/04)

Print and complete all sections of this form. The name and address is where we should send the receipt or exchange.
Indicate if you would prefer a refund or an exchange. If exchange, let us know what you'd like by completing the exchange information section.
Pack and seal your return securely (in the original package if possible) and include this page and the original receipt. We've provided a return label for your convenience. Packages must be returned prepaid-we cannot accept C.O.D. deliveries.

CUSTOMER INFORMATION:

 FIRST NAME:___________________LAST NAME: _________________________

 ADDRESS:__________________________________________________________

 CITY: _____________________  STATE: __________ ZIP CODE: _________

 EMAIL: ___________________________________

 TELEPHONE:  ( ___ ) _____ - _________

CREDIT CARD INFORMATION:

 NAME ON CARD: ___________________________ CARD TYPE: _________________

 CREDIT CARD NO. _________________________ EXP. DATE: ____________

ORDER INFORMATION:

 INVOICE NUMBER: ___________________      DATE ON INVOICE: ____________

 DATE PACKAGE RECEIVED BY CUSTOMER: __________________

RETURN INFORMATION:

 RETURN TYPE (check only one):   Refund ________  or  Exchange _________

 REASON FOR RETURN: ____________________________________________________

 _______________________________________________________________________

 EXCHANGE INFORMATION (Fill out if indicated Exchange above):

ORIGINAL ITEMS RETURNED:		Item ID	Item name/description	Qty	Price
	1
	2

NEW ITEMS REQUESTED:		Item ID	Item name/description	Qty	Price
	1
	2

FOR OFFICE USE ONLY (CUSTOMER - DO NOT FILL!):
Date received by customer: ___________ Date received from customer: ___________ Date shipped to customer: ___________	Amount credited to customer: ___________ Amount charged to customer: ___________ New order/invoice number: ___________
Notes: