Finn Comfort shoe repair, rubber sole


	Customer Service: 1-877-NUSHOE1 (1-877-687-4631)

ORDER INSTRUCTIONS
	Complete this order form. Upon clicking the “Submit Order” button, your information will populate the address fields at the UPS website for label printing
	Print and retain a copy of your order form including ticket and tracking numbers (next page); include a copy of the order with your footwear inside the box
	Include check or payment information
	Print the UPS label and tape to a box (next page)
	Drop your order at any UPS box or pick-up location.
Call toll-free 1-877-NUSHOE1 (877-687-4631) with any questions.

CUSTOMER INFORMATION ("*" indicates required field)

First Name: Last Name: Address Line 1: Address Line 2: City:	State: Postal Code: Daytime Phone: (5558882222) Evening Phone: Email:

SERVICE OPTIONS (select one)

Complete Renewal $140 Basic Renewal $80 Refreshment $55
YES, I authorize Replacement Components if original is unavailable. Please do not call me. There is a $20 shipping and handling charge for each package. Multiple shoes can be included per shipment.

SHOE CARE ACCESSORIES (select any)

Comfort Footbed $55 Extra Soft Footbed $65 Reflex Footbed $22 Cedar Shoe Trees (Dress Shoes) $25 Suede / Nubuck Kit $25 Smooth Leather Kit $25 Cedar Shoe Trees $25 Cedar Boot Trees $30 Military Dual Density Gel Insole $15 Military Boot Care Kit $20	Rough Out Leather Shampoo $8 Rough Out Leather Renewal Mojave $8 Rough Out Leather Renewal Tan $8 Black Edge Dressing $8 Leather Protector $6 Odor Away Fresh Scent $8 Shoe Cream (specify color) $6 Leather Conditioner $6 Suede and Nubuck Shampoo$8 Extra Laces (specify color & length) $5

SPECIAL INSTRUCTIONS

	Please include any special attention your order may require (250 MAX letters and spaces)
	Retailer Where Purchased:	Retailer Account Number:
	Ship To: Consumer Retailer

PAYMENT OPTIONS ("*" indicates required field)

Please select one*:
Check
Money Order
Visa
MC
Discover

No American Express please

(not required if Check or Money Order)
Name on Credit Card*:

Credit Card Number*:

Expires*:

Credit Card Security Number (3 digits)*:

Customer Signature*:
By clicking here, I authorize NuShoe to charge my credit card once my order has gone into repair.

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