ORDER INSTRUCTIONS

Customer Information(”*” indicates required field)

*
*
*
*
*
*
*
*

PAYMENT OPTIONS (”*” indicates required field)

Please select one*

SPECIAL INSTRUCTIONS

  • Ship to:

Not required if paying by Check or Money Order

*
*
*
*
*Customer signature:
PLEASE NOTE: Your Credit Card will not be charged until after your shoes go into repair.

Sub Total

Shipping

Total

and then advance to the UPS label printing page

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