Return/Exchange Form

Directions:

- Fill out this form completely. Incomplete/incorrect information will delay your return/exchange.

- Detach the top part of form and place inside the box with the merchandise.

- Complete the return address portion of the return label and attach to the outside of the box.

Order Number (printed on receipt): ______________________

Complete One of the Columns Below

____ I wish to return the items(s). - Non-gift items will be credited to the credit card used for the original purchase. - If the item(s) was a gift, a store credit will be issued and sent to the address provided below.			____ I wish to exchange the item(s): Replacement items(s) desired: ____________________________________________ ____________________________________________ If the cost of the replacement item(s) is greater than the returned items(s) please indicate the credit card you would like us to charge. ____ Bank Card Type of Card __________________________ Name on Card __________________________ Card No. ______________________________ Expiration Date _______________________ Signature _____________________________ ____ Bon-Ton, Bergners, Boston Store, Carsons, Elder-Beerman, Herbergers, or Younkers card Name on Card __________________________ Card No. ______________________________ Signature _____________________________ If the cost of the replacement item(s) is less than the returned item(s), you will be issued a store credit for the difference. This will be sent to the address provided below.

Name: ______________________________________________________

Address: _____________________________________________________

City: ___________________________________ State: ____ Zip: _______

Phone: (_____)_____________ Best time to call __________________

--------------------------------------- Detach Mailing Label Below and Place on Outside of Package ---------------------------------------