Payment Method
Home         Mailing Instructions
 
-Please fill out this page by printing it first, or if you choose, you may fill it out first and than print it. (Merchandise Return Label at Bottom of Page)
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By Check (to Newsole)   Money Order    Visa    Master Card

CARDHOLDER INFORMATION

Full Name

E-Mail

Street

City      State    Zip Code

Day Phone    Home Phone

Card Number     Expiration Date

Quantity           Type of  Repair Requested

    Deluxe Insoles  (optional)... $18.00 

    

    

           Shipping and Handling, Please add $14.00

           For Boots...........................   $18.00

           Additional pair.......  Please add $7.00    Total  $

           Further comments and return address if different from cardholder Information.

Merchandise Return Label                       

Simply cut out the label below  by printing it first.
Fill in your return address and tape it to the front of the package.
Please note that all postage fees will be billed to us once you affix
this label to your package. Your shipping and handling fee includes
freight to and from our center.