Netbride.com  SHOE ORDER FORM

1. Wedding date PLEASE Enter Month first! (Enter as MM/DD/YYYY):   

2. Brides First Name: 

    Brides Last Name: 

3. Home Address of Bride (required): 

4. Primary Shipping Name & Address (if different from Bride's name and home address, above). For domestic shipping (addresses within the U.S.), it’s best to use a work address as someone will be there to sign for the package. Also we require signature, so delivery may be delayed if sent to a residence. 
WORK ADDRESSES: UNABLE TO SHIP WITHOUT BUSINESS NAME, MAKE SURE YOU INCLUDE THAT. 

 

First Name:Last Name:

Business Name: (if shipped to business)

Address1:

Address2:

City: State: Zip Code:

Country:

 

 Is Primary shipping address a residence or a business?Residence     Business 

 

Note: For Additional Shipping Addresses - Include full address and which items from below need to be shipped to each address  in the "NOTES" (section 13) at the bottom of this order form (indicate whether residence or business on each, if business indicate business name and contact person):   Add $12 for each additional address  in 10d below.

5. Complete E-mail address: (required)

6. Phone day: (required)        7. Phone evening: (required) 

Designer Name: Style #:   Color:  

9. TOTAL PAYMENT 

 

Note: Shipping to continental U.S. is included in price.  Please call us for quote for shipping to anywhere outside continental U.S.

TOTAL OF ALL CHARGES:

10. Payment Method:      CHECK  CREDIT CARD

(Do not submit Order by Email if paying with check.  Please mail your Order along with your check)

 Enter Credit Card Number here, digits only:  (We accept Visa, MC, Discover)

Expiration Date of Card: 

Cardholder's name as it appears on credit card: 

Credit card billing address and zip code, if different  than brides home address:  

Last 3 Digits of Security Code on Back of Card (required):

(total amount of order will be charged to credit card; if more than one credit card, add $3 for each credit card to total amount in #8 and use box #11 for the additional credit card information)

ADDITIONAL SHIPPING ADDRESS 1:

What to Ship:

First Name:Last Name:

Business Name: (if shipped to business)

Address1:

Address2:

City: State: Zip Code:

Country:

 Is Additional Shipping Address 1 a residence or a business?Residence     Business 

ADDITIONAL SHIPPING ADDRESS 2:

What to Ship:

First Name:Last Name:

Business Name: (if shipped to business)

Address1:

Address2:

City: State: Zip Code:

Country:

 Is Additional Shipping Address 2 a residence or a business?Residence     Business 

 

ADDITIONAL SHIPPING ADDRESS 3:

What to Ship:

First Name:Last Name:

Business Name: (if shipped to business)

Address1:

Address2:

City: State: Zip Code:

Country:

 Is Additional Shipping Address 3 a residence or a business?Residence     Business 

 

ADDITIONAL SHIPPING ADDRESS 4:

What to Ship:

First Name:Last Name:

Business Name: (if shipped to business)

Address1:

Address2:

City: State: Zip Code:

Country:

 Is Additional Shipping Address 4 a residence or a business?Residence     Business

 

ADDITIONAL SHIPPING ADDRESS 5:

What to Ship:

First Name:Last Name:

Business Name: (if shipped to business)

Address1:

Address2:

City: State: Zip Code:

Country:

 Is Additional Shipping Address 5 a residence or a business?Residence     Business

15. BE SURE YOU RECEIVE YOUR CONFIRMATION (WE WILL EMAIL IT TO YOU WITHIN 3 BUSINESS DAYS OF PLACING THE ORDER).  IT IS YOUR RESPONSIBILITY TO MAKE SURE YOU GET YOUR CONFIRMATION AND THAT YOU CHECK IT OVER FOR ANY ERRORS.
 

(Signature if order is faxed or sent by US Mail. ..no signature necessary if sent by e-mail.) 

Bride: _____________________________________

Credit Card Holder: ___________________________

After you press SUBMIT ORDER, the computer will pause as it processes the order. Please do not hit the submit button twice as it is normal for the computer to pause while it processes your order for a few seconds. It will then show you a confirmation of your order in a few moments.