RETURN AUTHORIZATION FORM
Must be completed and included in all returns

Name:  ____________________________________________________________________________

Address:  ___________________________________________________________________________

City:  _____________________________________  State:  _______  Zip Code:  __________________

Date Purchased:  _____________________________________________________________________

Date Returned:  ______________________________________________________________________

Reason for return:  ____________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Please exchange for the following:  ________________________________________________________

__________________________________________________________________________________

______  Please credit my account less return fees.

Signature:  ___________________________________________________