Mail this form to: Village Shoe Service 4286 Railroad Ave. Tucker, GA 30084 |
Make your check payable to Village Shoe Service TEL 770-938-7463 - www.villageshoeservice.com |
SHIP TO Name ________________________________ Address ______________________________ City ____________________ State _________ Zip __________ Company Name __________________________ |
BILL TO Required If Different Must Match Statement Address Name ________________________________ Address ______________________________ City ____________________ State _________ Zip __________ Company Name __________________________ |
QTY | ITEM # / DESCRIPTION | SIZE & WIDTH | UNIT PRICE | TOTAL | |