Mountain Soles & Outdoor Threads Repair FormPlease print this form & include it with your shipment

Shipping Address:

Mountain Soles10824 SE Oak St , Suite 184

Milwaukie, OR 97222 www.mountainsoles.com

Email

Phone

Internal Use Only

Date Received:

Date Shipped Back:

Billing Address (where you get your credit card bill):

Cardholder Name

Repairs Needed/ Comments. Item/ Model/ Color:

Choosing this option may extend the turn around time.

Please just fix it! Proceed with repairs up to Email first with estimateWe won't contact you. This is the

fastest way to avoid delays.

Choose ONE option:

Want to insure your package for the return shipping?

No Yes, insure my package for $Insurance will increase return shipping costs

Shoe size of primary user:Female/Smaller Foot Male/Larger FootPrimary user of snowshoes:

For pricing information, please refer to our web site. If you request an estimate, please note that we do not contact customers if repair will cost less than $30 per item+ return shipping.

Return shipping will be calculated upon completion and added to your total repair cost.

Please review this page, print it, and sign it at the bottom. Include this form with your shipment.

You can cut out the address to the left,

tape it to your box, and then ship the box to us . Thank you!

Total Cost:

Return Shipping:

Repair Costs:

Repair Estimate = + Return Shipping

Notes:

Ship to:

Mountain Soles 10824 SE Oak St, Suite #184

Milwaukie, OR 97222

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City

Address

Customer Name

State Zip CodeZip CodeState

City

Billing Address

Same as Billing Address

DiscoverMastercard Visa

Expiration Date (mm/year): /

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Verfication #:

We DO NOT accept cash or checks.

The last 3 digits on the signature strip of your card.

All repairs are returned via US Mail

Card Number -- -

Cardholder Signature: ______________________________________ Date: ____________

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Package Dims: