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 -2 shoes on wood bookend bases 150L - 2 shoes on wood bookend bases 200 - two shoes, wood base, 8x10 frame 200 - two shoes, wood base, 5x7 frame 300 - one shoe on black marble base 330 - two shoes on black marble base 320 - Pacifier on black marble 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 for baby shoes are:  $35.00                                                               

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.