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:________________________________________________________________________

SHIPPING ADDRESS:____________________________________________________________

_______________________________________________________________________________

DAY AND EVENING PHONE NUMBER:____________________________________________

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

REPAIRS REQUESTED: (please don't make me try to remember a phone conversation or an email) please describe the nature of your repairs in detail here:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

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