ORDER FORM

• Custom made goods cannot be returned or exchanged, but we will be glad to remodel if a satisfactory fit is not received. All credit card order charges are put through at the time the order is entered. Goods shipped from stock will be willingly exchanged if unsatisfactory in fit or otherwise.

METHOD OF PAYMENT: (Check One) CHECK MONEY ORDER VISA MASTERCARD

CARD NUMBER (ALL DIGITS):______________________________________________________

EXPIRE DT:_____________________________________ CVV CODE _____________________

SIGNATURE: __________________________________________________________________

SHIP TO: _____________________________________________________________________

ADDRESS: ____________________________________________________________________

CITY: ______________________________ STATE: _________________ZIP: _______________

PHONE: _______________________________ EMAIL: _________________________________

Quantity Stock # Size
(Add Height of Boot in Inches)		 Price per Pair TOTAL






























WI RESIDENTS ADD 5.5% SALES TAX
 $
(add when ordering oversized footwear only) OVERSIZE CHARGE
 $
(add when ordering overseas only) OVERSEAS CHARGE
 $
(choose from shipping options below) SHIPPING & HANDLING
 $
We accept Master Card and Visa. Ship by UPS.
We ship UPS unless other specified.
UPS GROUND -
Order Total
Shipping Cost
$0-$75
$8.00
$75-$300
$11.50
$300-$500
$14.00
$500-$750 $19.00
over $750 $25.00
UPS Blue Label -
Add $18.00 to above total

Priority Mail -
Add $9.50 to above total

Overseas Charge -
Add $40.00 to above total
(Add Additional RUSH Service? Add $45.00 or $60.00 in addition to shipping costs) RUSH SERVICE
$
• Rush Service: If you are going on a hunting trip or need your boots or shoes in a hurry, for an additional $45.00 per pair we can ship within 30 working days, for $60.00 per pair we can ship within 20 working days. REQUEST AT TIME OF ORDER IF RUSH DESIRED

GRAND TOTAL
 $

• Extra for Overseas - Canada, Alaska, Hawaii and Mexico. Multi-Pair Shipment Orders Will Be Billed Accordingly.
• Please Check box(es) below for oversize charges. Extra-wide or unusual patterns will constitute an extra charge as seen below.

Men’s Oversizes
Women’s Oversizes
12-1/2-13 $6.00 9-1/2-10 $6.00
13-1/2-14 $8.00 10-1/2-11 $8.00
14-1/2-15 $16.00
15 1/2-18 $29.00
PLEASE DO NOT FAX THESE MEASUREMENTS AS FAX MACHINES DISTORT THE ACTUAL SIZE AND SHAPE. MAIL YOUR TRACINGS TO RUSSELL MOCCASIN AT THE ADDRESS BELOW.
W.C. RUSSELL MOCCASIN COMPANY
285 S.W. FRANKLIN
P.O. BOX 309
BERLIN, WISCONSIN 54923-0309
For further information, questions or comments please Email Us.
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