Name:

Address:

City: State: Zip:

Phone #:

E-Mail Address:

Date: Invoice #:

Item being returned:

Size: Color:

Reason for Return:

If you are exchanging an item, please write the new item:

If you are exchanging an item, please send proper shipping charges:

$0.00 - $50.00 = Add $5.25
$50.01 - $100.00 = Add $7.50

We accept checks and all major credit cards. If you'd like us to charge your credit card, please complete information below.

Circle one: Visa - Master Card - Discover - American Express

Card #: ___________________________________ Exp: _________

SECURITY CODE:__________

Name as it appears on card: ________________________________

Billing address for card:___________________________________

Amount: $ ____________

If you are paying by check, please give Check #:

Additional Comments: