To pay by check or money order, fill out, print and mail this form to the address below:

SHIP TO:

Name
Address
City
State & Zip

BILL TO (if different than above address):

Name
Address
City
State & Zip

OTHER CONTACT INFORMATION:

Email
Phone

No return accepted without authorization.  Authorization will be sent only upon request of written request at factory address, specifying style, size, color, and brief description of nature of damage.