10666 Renfaire Drive
Plantersville, TX 77363
Date received,__________
Date Shipped,__________
Ordered by:
Residence Phone: Email Address:
Ship to: Address:
City: State: Zip:
Please circle one: Check Money order Charge as follows: Visa Mastercard American Express Discover
Name of cardholder,_________________________ Signature,_________________________
Credit card number,_________________________ Expires,_________________________

Quantity

Style 

Size

Two color choices Price each ExtraLaces Total
             
             
             
             
             
             
             

Custom order fee- $15.00 - $40.00 (send foot tracing)*  
Shipping & Handling - $7.00
International shipping (including Mexico and Canada) - $22.00
Each additional pair - $4.00
Subtotal  
TX Residnts, please add 8.25% Tax (tot $ x .0825)  
Shipping  
Total Due  

Group rates for weddings, call for quote.
Orders are shipped Priority mail unless otherwise requested.
Delivery time allowance, approximately one week.  
Layaway customers, balance due in 3 months or deposit forfeited.
We can provide rush orders for Weddings and Special Occasions.

* Foot tracing for custom order, stand with your full weight on a piece or paper. Traces or have some one trace the out line of your feet. (hold pen straight) Send both fee with your order and custom order fee.

Boot measurements, please fill in below using inches.
Ankle,__________ Widest part of calf,__________ Below knee,__________
Height of leg from below knee to floor,__________
Height from widest part of calf to floor,__________

Toll Free: 800-824-7637
Email: renmocs@yahoo.com
         Website: www.renaissancemoccasins.com