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Exchange Form

Please print out this form and fill out all fields

1. Exchange Authorization Number: _______________________
You can obtain this code by contacting Customer Service.
2. Your Information:

Name: ____________________________________________________________
Address: __________________________________________________________
__________________________________________________________________
__________________________________________________________________
E-mail Address: ____________________________________________________________
Telephone Number: ____________________________________________________________

3. Order Information
Order Number:_________________

Reason for Exchange
_____________________________________________________________________
_____________________________________________________________________

Exchange Address:

Univest Trading Inc.
Att: Exchanges Department
22 W. 48th St. Suite: 1007
New York, NY 10036 USA

Please don't forget to write your Exchange Authorization Code on the outside of the package or we will not be able to accept your return.