DATE SENT:___________________________________________________________________

SPECIAL INSTRUCTIONS:(suit needed by specific date, etc)______________________________

AMOUNT QUOTED FOR REPAIR WORK __________________________________________

AMOUNT INCLUDED FOR RETURN SHIPPING _____________________________________

BRAND, MODEL AND SIZE OF SUIT ____________________________________________

NAME:________________________________________________________________________

RETURN SHIPPING ADDRESS: (please write this so we can read it)________________________

______________________________________________________________________________

DAY AND EVENING PHONE NUMBER:___________________________________________

E-MAIL: (make sure this is correct)___________________________________________________

REPAIRS REQUESTED: Please describe the specific nature of your repairs in detail here:

Brand and Model of Suit____________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_________________________________________________________________________________