divi contact Order Form

If the Shot Fits
Repair Service Order Form

This form is Repair Request ONLY. It is not a payment gateway. Bring a printed version of this page with your object to be repair.

Do not submit this form drop off repair work without prior contact with Teri.

Instructions:
1) Make Selections Using Dropdown Lists.
2) RIGHT CLICK on web page to get popup menu.
3) click PRINT.

Name

Phone

Email Address

Object to Be Repaired

Select Repair

Select Material

Select Materials

Select Material Select Material Leather - $15

Select Repair

Select Material

Select Materials

Select Repair

Select Materials

Select Marterials

Select Materials

Style

Boot Repair

Select Materials

Boot Repair

ortho Repairs

Additional Requests

Color

Size

Brand / Designer

Notes:

6 + 6 =