ORDER FORM

  Your name and address:                                           Your Shoe Order:

    Our Style Code:  
  Your usual size:  
  Measurements: Left Foot: Right Foot:
  A:    
  B:    
  C:    
Phone:   D:    
Mobile:   E:    
Email:   F:    

 

Working out the price:                                              Your  preferences:

Price of Footwear     Colour ( check if available with your chosen style):
saddle-tan  O         medium brown O             dark brown  O
mahogany  O                      black O          custom dyed  O
Small extra Heel or triangular heel riser(£15.00)  
Heel Cushion (£4.00)   Do you want a triangular heel-riser with your Dark-Age Shoes?  £15.00      O
(check if available with your style - no small extra heels with this)
Vampstripe (£15.00)   Do you need extra room for thermal insoles or socks that were
NOT included when taking measurements?
Note: NO orthopaedic insoles to be worn with ANA shoes unless agreed otherwise.
Postage within UK
£4.00 for DAM, LML + LMF
ALL other styles £7.00 		  Will additional sole-layers be glued on by a modern cobbler?                      O 
(We will NOT oil your shoes so that their modern glue sticks better)
    How did you hear about us?
Total   On which occasions will you wear our footwear?

If ordering more than one pair:
Please staple the order forms to the foot-drawings they belong to as this avoids misunderstandings.
Contact us for the correct postage for the entire parcel as you may be eligible for a discount.

 

Checklist:
•Completed order form
 •Outline of your foot and measurements
•cheque or postal order made payable to A. DEISSLER

When your order is complete please post it by ordinary mail to:

ANA, 26 Vicarage Terrace, Treorchy, Mid Glamorgan, CF42 6NA, Great Britain

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© Ana Deissler March 2007