Dance Shoes
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Address:     Apt #: 
City: 
State:           Zip: 
Phone:    Cell phone:
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Styles # Color and Material US Size Heel Height Width
(Regular/EE/EEE)		 Qty Unit Price  Total
Accessories Item # Product Description Color Qty Unit Price Total
Total Amount

 We will bill you though Paypal    Yes        No   
Solution Graphics

To Pay by Mail Please  fill in your order,   print a copy to mail with your check or money order 
payable to Jerry Pariseau
                 
                          Jerry Pariseau  
                         P.O. Box 928  
                              Gold Hill, Oregon 97525
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