| SERVICE | QUANTITY | PRICE | TOTAL PRICE |
|---|---|---|---|
| MEN'S | |||
| Heels - Shoes or Boots | X | $20.00 | |
| Rubber 1/2 Soles | $40.00 | ||
| Rubber 1/2 Soles & Heels | $60.00 | ||
| Leather 1/2 Soles | $40.00 | ||
| Leather 1/2 Soles & Heels | $60.00 | ||
| Vibran Cushion Full Soles | $60.00 | ||
| Rugged Outdoor Full Soles | $60.00 | ||
| Protective Full Soles | $30.00 | ||
| Protective Full Soles & Heels | $40.00 | ||
| Leather Full Soles & Heels | $75.00 | ||
| WOMEN'S | |||
| Small Toplifts | $10.00 | ||
| Medium Toplifts | $13.00 | ||
| Large Toplifts | $15.00 | ||
| Protective1/2 Soles | $20.00 | ||
| Vibran Cushion Full Soles | $50.00 | ||
| Rubber 1/2 Soles | $30.00 | ||
| Leather 1/2 Soles | $30.00 | ||
| Sport & Walking Shoe Heels | $25.00 | ||
| OTHER SERVICE WORK (price on request) | |||
| Shinning | $8.00 | ||
| Stretching | $12.00 | ||
| SHIPPING INFORMATION | ||||||
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| Mailing Address: | ||||||
| City: | State: | Zip: | ||||
| Day Phone: (Phone number is important should dealer need to discuss your repair.) | ||||||
| PAYMENT METHOD | ||||||
| PLEASE CHECK PAYMENT: | ||||||
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