B. Nelson Shoe Repair ORDER FORM
Mail this order form to: 140 East 55th St. New York, New York 10022

Name:         Date:
Shipping Address:
City:       State:         Zip:
Daytime Phone:  Daytime Fax (opt.): 
Email (opt):

Repairs for Birkenstock shoes:
Heels
$35.00 pr.
Resole
$50.00
Recrafting: (replace footbeds and soles)
$80.00
ADD: $20 for shipping
Please make out check or money order to VIP Shoe Restorers
METHOD OF PAYMENT:
  AMEX   Mastercard   Visa   Check   Money Order
Credit Card #:
Expiration: Month       Year