Merchandise Return Form

Original Transaction Date ______________ Transaction Number ____________ Date of Return __________________

Name _________________________________________________________________________________________________________

Address ________________________________________________________________________________________________________

City ______________________________________________________________ State _________________ ZIP __________________

Contact Number ___________________________________________ E-mail Address _____________________________

Drivers License Number ___________________________________________ State of Issue _________________________________

Reason for
re turn (c ode ) Ite m Q ty U nit pric e Tota l pric e
_________ ________________________________________ _______ ___________ ___________
_________ ________________________________________ _______ ___________ ___________
_________ ________________________________________ _______ ___________ ___________
_________ ________________________________________ _______ ___________ ___________

Exchange for: Item (name) ____________________________________ Color _________ Size _____ Price _______ Qty____
Return for refund.

Return reason codes: 1 — Defective 2 — Damaged 3 — Wrong size 4 — Wrong item 5 — Other

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