BASS RIVER SHOE REPAIR ORDER FORM

Print this form and put it in the box with your shoes. Use bubble wrap, tissue paper or newspaper to cushion your shoes and prevent movement in the box during shipping.

CUSTOMER INFORMATION

Name:  ______________________________________________________

Address: ____________________________________________________

______________________________________________________________
    
Daytime Phone: ______________________________________________
    
E-mail: ______________________________________________________
    


SHIPPING INFORMATION

 Ship the items needing repair to:
Bass River Shoe Repair
146 Old Main Street
S. Yarmouth, MA  02664

THANK YOU FOR YOUR BUSINESS!  We enjoy serving you!