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 (nordic blue, red, turquoise, white, black, or pink)  
Amount Enclosed:  
Multiply number of Shoe Weight sets by $36 plus $7.50 shipping and handling for each set.    $(36 + 7.50) * Number of sets
Total Enclosed = $

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.)