Please fill out the form and click REVIEW.
Review your information and revise as necessary.
Then print it and include the order page with your shoes.
If you have more than one pair of shoes the information for the other pairs can be added to the "other comments" box.
No printer, no problem. Just provide a note with your repair instructions and contact info.
Thanks! (credit card info will be displayed on a secure page).

Ship to:

Name:
Address:
Address (cont.):
City:
State:
Zip Code:
Phone:
Email:
Shipping:
	please add $2.00 for each add'l pair

Bill to: (if different):

Name:
Address:
Address (cont.):
City:
State:
Zip Code:
Email:

Order Information:

Sole:
Rubber:
Rand Repair:
Begin Work:
T-Shirt: $18
	plus tax
Other Comments:

Billing Information:

Method of Payment:
Name on Credit Card:
Credit Card Number:
Credit Card Expiration:
Security (CVV) Code:

The Rubber Room
175B North Main Street
Bishop, CA 93514

Email: resole@rubberroomresoles.com
Call (760) 872-1363 or Toll Free (888) 395-ROCK
Site Design by www.nilsdavisdesign.com