Name:

Address:

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Rubber Preference: Five Ten C4 Mad Rock #5 La Sportiva XSV

Shoe Make: Date Needed by:

STANDARD Half Soles $32.00 / per pair	THICK Half Soles $34.00 / per pair
Toe Rands $10.00 each	New Laces $2.50 each
Birkenstock Resole $35.00 / per pair	Teva Resole $30.00 / per pair
Approach Shoe Resole Full $40 / Half $30 / per pair	T-Shirts $15.00 / per pair Medium Large X-Large   Sand Beige Stonewash Blue Stonewash Green Charcoal Orange

*If shoes are sent insured and require a signature, your order may be delayed or not received at all.

Shipping & Handling Fly'n Brian uses US Priority Mail (2-3 days typical) 1 Pair $8.00 2 Pair $10.00 3 Pair $12.00

4 Pair $14.00 5 Pair $16.00 6 Pair $18.00

Turnaround Time Be sure to specify date needed in space provided above. Standard (3-4 Weeks)* $ Free 3 business days / $5 per pair   *Call or email for current status.

Card Number: Expiration Date: Signature: X