Instructions:

Fill out this form online. When all fields are complete, print this page.
Mail completed form and shoe(s) to:
Steppin' Birkenstock
12 Chambers Street
Princeton, NJ 08542

Feel free to email us or call toll free 866-722-4757 with any questions.

After printing form, click this to close the window and return to Steppin' Birkenstock Shoes.

ITEM NAME OR STYLE#
SIZE AND WIDTH
SELECT ACTION COST X QTY. = COST
RESOLE $65.00/pair X = $
RESOLE/RECORK $75.00/pair X = $
RECRAFT/CLASSIC $95.00/pair X = $
RECRAFT/SOFT FOOTBED/HIGH ARCH
$105.00/pair X = $
HEELTAPS $55.00/pair X = $
TOE TAPS $55.00/pair X = $
RELINE SUEDE LINERS $55.00/pair X = $
REPLACE BUCKLES $25.00/buckle X = $
SHOE RESOLE $110.00/pair X = $
SUEDE CORK FOOTBEDS $46.00/pair X = $
COTTON CORK FOOTBED $22.00/pair X = $
SUBTOTAL $
SHIPPING: $10.00(FIRST PAIR)
$3.00 (EACH ADDITIONAL PAIR)		 $
TOTAL $

Contact Information *required fields
*Name
*Phone
Email Address
*Address
*City   *State
  *Zip    
Billing Information (all fields required)
Check if Billing Information is the same as Contact Information
Name on Credit Card
Billing address
City State
Zip
Card Type
Card Number Expiration /
CID/CVV2 #

Signature
 
 

After printing this form, click this to close the window and return to Steppin' Birkenstock Shoes.