JGear Exchange Authorization Form

( Please include this form inside the box with the exchange )

Order Number :_______________________________________________

Customer Name:_______________________________________________

Customer Address:_____________________________________________

City:___________________________State:________Zip:______________

Telephone Number w/Area Code:_________________________________

E mail Address:________________________________________________

Brand & Style:_________________________________
Size:_______ Width_______

I Would Like in Return:

Style:____________________ Size:_________ Width_________

- - - - - - - -Please Cut here and tape onto the outside of the box - - - - - - -

Send to:

JGear, Inc.
Returns Department
1211 Rickmeyer Drive
Fond du Lac, WI 54937