Shoe Weights ™ Order Form

 
 
Full name (first and last):
.
E-mail address (optional): .
Daytime Telephone Number (optional): .
Evening/Weekend Phone Number (optional): .
 
Your Address:  
Street Address 1: .
Street Address 2: .
City .
State .
Zip Code .
Country (if other than USA): .
 
ShipTo Address
(if different from above)		  
Street Address 1: .
Street Address 2: .
City .
State .
Zip Code .
Country (if other than USA): .
 
Shoe Wight Information:  
Number of Shoe Weight sets
(6 weights per set)		 .
Color (blue, white, pink, or black) .
 
Amount Enclosed:  
Multiply number of Shoe Weight sets by $30 . .$
Shipping and Handling + $ 6.50
Total Enclosed (add above amounts together) = $

Please print this page, fill it out, and mail it, along with payment, to Shoe Weights, P.O. Box 837, Longmont, CO 80502. Thank you!
(Note: If you cannot download this form, please supply the same information as above on a separate sheet of paper.)