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STANDARD ORDER FORM

 
SHIPPING ADDRESS
CREDIT CARD BILLING ADDRESS
(Must have if different from shipping address)
NAME:     
ADDRESS:    
     
E MAIL ADDRESS:    
PHONE:    

Style#  Model Color Size Quantity Price Total
             
             
             
             
             

SHIPPING WILL BE ADDED (USUALLY UPS GROUND)

 

 

 

MAIL TO:
E Footwear
Attn: John Elison
4221 Edgemont Ave
Brookhaven, PA 19015

PLEASE FAX TO: 484.480.3044
METHOD OF PAYMENT:
Credit Card (Check One)
VISA MASTERCARD DISCOVER
AMEX (+$9.99 U.S. Shipping) MONEY ORDER (+$7.99 U.S. Shipping)
List Card #: _________________________________________
List Exp. Date: 
_________
Month
_________
Date
 _________ 
Year

*_________________________
Credit Card Signature
*(Must Have)

 
PLEASE NOTE:  ANY STOLEN OR FRAUDULENT CREDIT CARDS WILL BE PROSECUTED. WE CHECK OUT ALL CREDIT CARDS BEFORE MERCHANDISE IS SHIPPED.