Return Form

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
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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

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 +