Text Box: Name ___________________________________________________________
 
Address _________________________________________________________
 
_________________________________________________________________
 
Telephone #______________________________________________________
 
E-mail address_ ___________________________________________________
 
Would you like to be informed of new items by e-mail? _________________ 

Reason for return: ____________________________________________________

Text Box: FMSTA @ MSPPHQ-RETURN FORM

Text Box: Pay by: (circle one)
             check 
             credit card 
             cash
             money order 
 
Original invoice # 
 
______________

Text Box: Send to: 
MSP@PHQ
c/o Creative Touch Designs, LLC
72 Elm Street
Salisbury, MA 01952
www.modestapparelusa.com
info@modestapparelusa.com
Toll free 1-866-269-0907 or 1-417-345-8421
 

Text Box: SHIPPING CHARGES-Send UPS Ground 3-7 days

SIZE

Item #

Color

Description

QNTY

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Subtotal

 

 

 

 

 

tax

0.00

 

 

 

 

shipping

 

 

 

 

 

Total

 


.01-12.00

2.00

 

12.01-39.95

4.95

 

40.00-99.99

7.95

 

100.00-199.99

10.95

 

200.00-up

13.95 +