Name: ...............................................................................................................

Address: ...........................................................................................................

Phone Number: ...............................................................................................

Drawing of boot or shoe

Style Name: .................................................................................................

Colours: .......................................................................................................

Extras: ..........................................................................................................

Price Aus$ _______

Measure around leg at these heights:

(continue every 5cm to desired height of boot)

10cm

15cm

20cm

25cm

30cm

Pointed heel measurement: ______ cm Usual shoe size _____(specify country) Body height.................................................................................................. Weight ..........................................................................................................

Extra considerations?

....................................................................................................................................................................................................................

* If foot is long, please trace diagonally across page