SHOE ORDER FORM

PRINT NAME    DATE    PHONE

ADDRESS    APT    CITY    STATE    ZIP

COUNTRY

RECOMMENDED BY:

FOOT SHOE SIZE: (WOMEN'S)     MEN'S    SOLE LENGTH 12"

SOLE LENGTH 13.5  (WOMEN'S)    SOLE LENGTH 15"  (MEN'S) 

SOLE 17" EXTRA LONG  (MEN'S)    SHOE COLOR    WITH BLACK SOLE

SHOE STYLES:

* ALL SYNTHETIC SHOES IN STOCK $ 150.00  ( TWO PAIRS $ 260.00)

* CUSTOM SYNTHETIC ORDERS $ 160.00/PAIR

* CUSTOM LEATHER ORDERS $ 235.00 (WOMEN'S) , $ 250.00 (MEN'S)  ANY STYLE

   NOTE: SOLES ON LEATHER SHOES ARE PROFESSIONALLY GLUED AND STITCHED

PAYMENT METHOD

   VISA/MC    AMEX    EXP. DATE

   MAILING ADDRESS WHERE YOUR CARD STATEMENT GOES    CITY

   STATE    ZIP    COUNTRY

   *** CHECK/M.O PAYABLE TO:                    "FEATHERS THE FANCY CLOWN"

                                                              1965 SW 25 Terr., Coconut Grove, FL 33133-2415 USA

phone/fax: (305) 285-9454