Memories in Bronze

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

          Please provide the following product information:

Desired finish:	--Select Finish-- Bronze Pewter Silver Gold
Number of shoes:
Item #:	000 - pair of baby shoes (unmounted) 001 - single baby shoe (unmounted) 003 - single child's shoe (unmounted) 004 - pair of children shoes (unmounted) 100 - one shoe, wood base, 4x6 frame 100 - one shoe, wood base, 5x7 frame 126 - two shoes, wood base, 8x10 frame 126 - two shoes, wood base, 5x7 frame 130 - one shoe on wood base 132 - two shoes on wood base 135 - two shoes on wood base 150 - two shoes on wood bookend bases 150L -two shoes on wood bookend bases 200 - two shoes, wood base, 8x10 frame 200 - two shoes, wood base, 5x7 frame 400 - two shoes, bronze base, 8x10 frame Pacifier - unmounted Adult Shoes - Single Adult Shoes - Pair Boots - Hiking, Work or Combat Boots - Cowboy Hats - Baseball Cap, Hard Hat or Combat Hat Hats - Military Covers & Police Hats Hats - Cowboy, Trooper or Drill Sgt. Hat Hats - Firefighter Helmet Baseball Gloves Balls - Golf Ball, Baseball/Tennis Ball, Football, Hockey Puck Hand or Foot Castings

Payment Method	--Choose Method of Payment-- VISA MasterCard American Express Check Money Order *
Cardholder Name
Card Number
Expiration Date

Security Code
	*If you prefer, we can get credit card info over the phone once we receive your items.
	SHIPPING* if different from above
Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

          If ordering a wood base:                       --Select Wood Base-- Oak Walnut                    

          Please select type style for engraving:    --Select Type Style-- Block Script   

          Special Instructions:         

                                                                                                                            Sub Total 

                Shipping* 

Total 

*Standard shipping charges are:                                                                 

  $29.95 for un-mounted baby shoes                                                           $33.95 for Mounted baby shoes                                                             

Please Call for shipping prices on adult shoes, boots, hats and mounted large items.    

      All prices, terms, and conditions are subject to change without notice.

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