Memories in Bronze

Order Form

Please fill in all fields below.  If a field does not apply, leave it blank. Print out the form and mail with your order.

 

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Telephone
E-mail

          Please provide the following product information:

Desired finish:
Number of shoes:
Item #:
Payment Method
Cardholder Name
Card Number
Expiration Date

Signature

SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
          Child's name and birth date as you want it to appear on nameplate:

          

          If ordering a wood base:                      

          If ordering a marble base:                      

          Please select type style for engraving:     

          Special Instructions:         

                                                                                                                            Sub Total 

                Shipping* 

Total 

          

*Standard shipping charges are:                                                                 

   $12.95 for unmounted baby shoes                                                            

$15.95 for mounted baby shoes, unmounted adult shoes, boots, hats, etc., 

 $25.95 for mounted adult shoes, boots, hats and large items.                      

  

      Important Disclaimer: In the very unlikely event of loss in transit, etc., we cannot be held responsible beyond intrinsic value up to $10.00.

Cut out our address below and attach it to your package to send with your order.

 

                                                                                      

                                                                                Memories in Bronze

                                                                                4365 Rhododendron Dr.

                                                                                Florence, OR  97439