RETURN INFORMATION SHEET

387 Clifford Rd Selinsgrove, PA 17870 570-374-2300

To insure an accurate and timely credit for items you are returning: Print this form. Complete this form, providing requested information. Send the items you are returning, this completed form and the packing slip to using the address above. NAME: _________________________________ ORDER NO.___________________ Address: _________________________________ _________________________________ City___________________ State______ ZIP_____________ Credit Card Information: Type of Credit Card (e.g. Master Card, Visa) _____________________ Credit Card Number ____________________________ Expiration Date ___________________________ Please complete following information regarding the items returned. Item Number Qty. Price/each Price Total Reason for return