| We will notify you via e-mail of your refund once we have received and processed the returned item. You can expect a refund in the same form of payment originally used for purchase within 14 to 21 business days of our receiving your return. |
| Order Information | |
| Transaction # | |
| Amount | |
| How Did You Pay | |
| Personal / Bank Check | |
| Money Order | |
| Pay Pal | |
| Credit Card | (If you checked yes) Fill out next section |
| Credit Card Information | |
| Credit Card | |
| Card Number | |
| Exp. Date | (mmyy) |
| Check | |
| Customer Billing Information | |
| First and Last Name | |
| Company | |
| Address | |
| City | |
| State/Province | |
| Zip Code | |
| Country | |
| Phone | |
| Fax | |