We will be closed March 11-27
for a medical vacation
(Sheryl's getting a new knee)
Sorry for any inconveniance.
Back on Monday the 30th!

MAIL TO :
High Street Shoe Repair
233 High St. NE
Salem, OR 97301

SORRY, WE DO NOT SHIP INTERNATIONALLY

PRINT AND INCLUDE THIS FORM WITH YOUR SHIPMENT

Customer Information

NAME

SHIPPING ADDRESS

CITY STATE ZIP CODE PHONE

EMAIL

BILLING ADDRESS SAME DIFFERENT

IF DIFFERENT

Repair Order

BRAND COLOR REPAIR COST

REPAIR

DR. MARTEN SOLES   Circle One (4014 / 1705) HAFLINGER / STEGMANN SOLES   Circle One (1030 / 1328) SAS SOLES Circle One (1030 / 1328) LIFT   – SIZE OF LIFT : COWBOY BOOT ZIPPERS

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Payment

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CARD TYPE VISA MC

CARD # EXP DATE MM/YY

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