Date: _______________________Authorization #_______________ Name: ____________________________________________________________________________ City/State/Zip:________________________________________________________________________ (make sure the billing address is the same as above, otherwise give the billing address for the card, including zip code) Credit Card Information:_________________________________________________Exp:________________ Item Exchanging/Returning: Size:_______________Color_______________________Style__________________________________ Reason for Exchange (be specific)_________________________________________________________ Replacement Item: Size:_______________Color________________________Style_________________________________ |