Check Appropriate Reponses

Please replace __________________________________________
Please exchange for _____________________________________
Please refund by method of payment 
   (shipping & handling costs will not be reimbursed) 
Other (please explain) _______________________________________________
   _______________________________________________________________________
   _______________________________________________________________________

Why?

Defective (please explain) _________________________________
   ________________________________________________________
Wrong item or size shipped
Wrong item or size shipped
Other (please explain) ____________________________________
   _______________________________________________________
   _______________________________________________________

Sales Order #  ___________________________________________
Name (under which order was placed) ____________________________
Member # (if applicable) ____________________________________