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Please fill in the following fields, then print this form out and include it in the package you return. We charge $15 shipping for exchanged merchandise ($20 to Hawaii and Alaska).

Please return merchandise via UPS or United States Postal Service to:

Homer Men and Boys' Store
9-11 South Main Street
Homer NY 13077



Order Number:

Item Was:

Purchased by me
Gift from

Action Requested:

Exchange Refund

Credit card number:

Expiration date: (mm/yyyy):

Exchange information:
product number, quantity, size, color, and description of item requested