CUSTOMER RETURN FORM

1) Contact Information

Name:____________________________________________

Address:__________________________________________

City:____________________ State:________ Zip:_________

Email:_____________________________ Ph:_____________

Your Order Number:_________________________________

2) Shipped To If Different

Name:____________________________________________

Address:__________________________________________

City:____________________ State:________ Zip:_________

Email:_____________________________ Ph:_____________

3) Reason For Return

Wrong Size Ordered:_________________________________

Defective:__________________________________________

Other:_____________________________________________

4) How Shall We Resolve Your Issue?

Merchandise Exchange: YES______________NO__________

If Yes/Reorder Here: Style:_________________Color:___________________Size:______

If the value of your exchange exceeds the cost of your original purchase we will charge your credit card for the difference.

Credit Card: YES, Charge My Card For Balance Due:________________________(add your initials)

Kanner Corporation
Attn: Returns
1467 Lawrence Drive
Thousand Oaks, CA 91320