Hitchcock - Wide Shoes for Men - Backorder Notice Reply Form

Backorder Notice Reply Form

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

Name: *
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.
	Email

comments/instructions: