Backorder Notice Reply Form

Note: Items marked with an * must be filled in.

Name:*
Email:*
ZIP/POSTAL CODE: *
KEYCODE NUMBER: *

(may be found on catalog label, packing list or backorder notice)
ORDER NUMBER: *
BACKORDERED STYLES: *
CLICK ONE: I am willing to wait for delivery of my order. If some unexpected delay makes it impossible to meet the tentative date you have given me, I understand you will provide a revised delilvery estimate. (I may, of course, cancel or modify my order at any time prior to shipment.)
  Please change my order. Send me instead:
  1st choice 
2nd choice
3rd choice
  Please cancel my order and refund any prepaid balance due to me.
ACKNOWLEDGEMENT: Please send me an acknowledgement of my change/cancellation.
   
comments/instructions: