Town View Leather
165 Ripley Road
Dexter, ME 04930
Telephone: (800) 973-6654

If shipping address is different than buyer, please specify on back of this form.
(i.e. if this is a gift, etc.)

Ship to: Name _____________________________________________________________ Street _____________________________________________________________ City, State _________________________________________________________ ZIP/Postal Code, Country ____________________________________________ E-mail address _____________________________________________________ Phone _____________________________________________________________ (important!) Card #_____________________________________________ Expiration Date _____________________ VISA - MASTERCARD (please circle one) Signature_____________________________________

NOTE: order your normal shoe size _____________

ITEM / COLOR	QUANITY	SIZE	MENS or WOMENS	LINED or UNLINED	Price             each	TOTAL
SUBTOTAL
Maine residents required to pay 5% sales tax
FREE SHIPPING
GRAND TOTAL