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
DISCOVER

CARD NUMBER (ALL DIGITS):______________________________________________________

EXPIRE DT:_____________________________________ CVV CODE _____________________

NAME:____________________________________________________________________

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
 $
(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
$11.25
$75-$300
$15.30
$300-$500
$17.25
$500-$750 $25.50
over $750 $32.00
UPS Blue Label -
Add $30.00 to to UPS Charge

Priority Mail -
Flat Rate $20.00

Overseas & Mexico
Flat Rate $65.00

Canada, Alaska, Hawaii
Flat Rate $45.00
Russell Moccasin can no longer accept rush orders. Due to our heavy workload, Russell can not promise a rush order delivery date at this time.
 $------------------

GRAND TOTAL
 $

• 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
12-1/2-13 $9.00
13-1/2-14 $11.50
14-1/2-15 $21.00
15 1/2-18 $41.00
Please do not fax or email these measurements and tracings as they distort the actual size and shape. Please mail your order along with your foot tracings and measurements to 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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