P.O. Box 811464
Chicago, Illinois  60681

Return-Exchange Form
Please allow 10 days for your return to reach us.  A credit or refund will be issued immediately.

 

Ordered By:

Name:_________________________________________

Address:_______________________________________

City, State, Zip:__________________________________

Area Code, Telephone:_____________________________
 

Style #

Qty.

Item Description

Size

Price

Postage/Delivery cost is non-refundable

Total Refund Due

$________

Exchange Section

Style #

Item Description

 Qty.

Size

1st
 Color Choice

2nd Color Choice

Unit Price

Total

CREDIT CARD PAYMENT: (Please circle)

            

________________________|__________
     Credit Card Number   Exp. Date

__________________________________
Signature

Merchandise Subtotal 

$ 

Illinois Deliveries
Add 10.25% Sales Tax 

$

Delivery Charge
(See Chart) 

$

Total Amount 

$