| NAME | ||
| STREET | ||
| CITY | ||
| Province/State | ||
| Country | ||
| Telephone | ||
| Name of Boot Style | _________________________ | |||
| Color Desired | _________________________ | |||
| Type of Sole Desired | _____Leather_______Rubber | (Circle only ONE!) | ||
| Leather Lining? | _____Yes__________No | (Circle only ONE!) (This is an EXTRA COST option!) | ||
| Your size? | _________________________ | (ie. US9/UK8/EUR42) |
| # | Measurements | Left | Right |
| 1 | Length of Foot | _____ | _____ |
| 2 | Measurement around toes/ball of foot | _____ | _____ | ___
| 3 | Instep | _____ | _____ |
| 4 | Heel to Instep | _____ | _____ |
| 5 | Measurement around ankle | _____ | _____ |
| 6 | Calf measurement | _____ | _____ |
| 6A | Height of measure 6 | _____ | _____ |
| 7 | Measurement AROUND leg under knee | _____ | _____ |
| 7A | Height of measure 7 | _____ | _____ |
| 8 | Measurement AROUND knee | _____ | _____ |
| 8A | Height of measure 8 | _____ | _____ |
| 9 | Measurement AROUND leg above knee | _____ | _____ |
| 9A | Height of measure 9 | _____ | _____ |
| 10 | Measurement AROUND thigh | _____ | _____ |
| 10A | Height of Measure 10 | _____ | _____ |
| 11 | Inseam measured along leg contour | _____ | _____ |
| 12 | Waist | _____ | _____ |
| 13 | Height of waist measured along outseam on leg contour | _____ | _____ |
| 14 | Inches of "sag/pleating" desired - 3" to 7" | _____ |
| Name as it appears on card: | ||
| Card #: | ||
| Expiration/Expiry Date: | ||
| Name of Bank/Institution: | ||
| Signature of Cardholder: | ||
| (As it appears on card!) | ||