! Today's Date: Exchange and Return Form Please select One of the following options: Exchange Item Refund/Credit *applied to the Original Credit Card only * Step 1 Original Order # (if available) Estimated Order Date: Customers Name: Billing Information Send Exchange to: (if different from left) Name Name Address Address Apt/Blding # Apt/Blding # City State Zip City COUNTRY State Zip COUNTRY Telephone: Telephone: Email Email Step 2-RETURNS In the form below please indicate the item(s) you are returning, including the reason code. Comments: if you need more room please use the back of this paper. Thank you. Where did you buy your item(s)? Versagripps.com Order #: Amazon Order #: Ebay Order #: Reason Quantity Size Style Color Price Reason Codes Total 5 -Too Small 17 - Do not like Style 7 -Too Large 11- Wrong item shipped 23. Ordered Wrong Size Step 3 - EXCHANGES Quantity Size For Fastest service, place a new order online or by phone. We'll ship your new item right away. Style Color Price RETURN SHIPPING Total First Class FREE (1 pair) (7-10 business days) Only USA Priority Mail $4.95 (3-4 business days) Only USA International (shipping options emailed for your approval) Step 4 Method of Payment If the total of your exchange or new order exceeds the value of your return, please provide a payment. Check or Money Order enclosed Credit Card Credit Card Information: Visa Mastercard Enclose this form along with the merchandise in a secure package. We Card #: recommend that you return your items via an insured and traceable carrier service. Expiration Date: Power Gripps USA is not responsible for lost packages in transit. Original Shipping Signature: and return shipping costs are non-refundable. Please send your package to: Power Gripps USA, Inc. Attn: Returns Processing 41 Pomola Ave Sorrento, ME 04677 Questions? Please call us at (207) 422-2051 or Email Customer Service: customerservice@versagripps.com American Express Discover Security Code We will issue a refund to the original credit card only if the merchandise is returned in resalable condition & in the original packaging within 30 days of purchase. After 30 days, it will be evaluated by our Returns Department to determine if the product is defective & qualifies for merchandise credit. If the product falls under our normal-wear policy the product will be returned to the customer. Refunds willl take 10 days & exchanges will take 20 business days from the date of receipt. Refer to www.versagripps.com for more information.