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High St. Shoe Repair

233 High St. NE

Salem, OR  97301-3643

3 EASY STEPS...

1. COMPLETE SHIPPING FORM- You can either type into this online form and  print it or... print the blank form and write it by hand.

2. SHIP YOUR SHOES TO US WITH THIS SHIPPING FORM ENCLOSED.

3. YOUR SHOES WILL BE SHIPPED BACK TO YOU BY U.S.P.S PRIORITY MAIL WITH DELIVERY CONFIRMATION.

 NAME:

 CARD TYPE:

VISA     MC   

 ADDRESS:

 CARD #:

- - -

 CITY:

 EXP DATE: 

(MM / YY)   

STATE:

    ZIP                            CARD ID NUMBER

                                                                                                        ( LAST 3 DIGITS ON BACK OF CARD )

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