Complete this form. You will also need to include or send a photograph of your cut-up magnetic trivets to obtain your free replacement trivets. The replacement trivets do not include magnets. Step 1 - Fill in your contact information First Name Last Name Address Street Address (Not a P.O. Box) Street Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip/Postal Code Email Address Phone Number Step 2 - Check the appropriate boxes, insert the quantity of trivets, and sign and date the request form: Number of trivets acquired Order Number I acquired the trivets from: (Select one) - None -TristarQVCI don’t know or don’t remember Agree I certify that I have cut all of my magnetic trivets into four pieces and have thrown the pieces, including the magnets, in the trash or that I have returned all of the trivets to Tristar: By Checking this box you are agreeing that you have followed the above steps. Photographs Photo One file only.32 MB limit.Allowed types: jpg png. Photo2 One file only.32 MB limit.Allowed types: jpg png. Photo3 One file only.32 MB limit.Allowed types: jpg png.