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your return address here
The Cobbler & Cordwainer
...............................Mailing label above-cut here and tape to package................................... To print this form; open
file, select print.
|Back to the ROCK SHOE FORM|
Enclose this form with your order (or go to the rock resole
page form). Please note: I am only resoling rock shoes these days. No
other repairs, I am making time for
Name ______________________________Phone __________________ext.____
EMAIL / FAX, etc._________________________________________________________ Billing Address _______________________________________________Apt. # _______ City _____________________________________________State _______ Zip ________ UPS Shipping Address (If different )_________________________________________________ Address______________________________________________Suite, or Apt.# _______ City _________________________________________State ________ Zip __________
MC or VISA #_____________-____________-____________-___________exp______ You may also prepay by check (If you do not know the price,
you may request a quote before beginning work.) Please note: I have suspended my general repair services Boots, Birkenstocks and general repairs. To print this form; open file, select print. Please write any notes below and add pages as needed. |