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Il Riccio di Rossi Michele
Via D. Chiesa, 36
58100 Grosseto - Italy
Tel. & Fax +39-0564-417593
Url: Http://www.ilriccio.it - E-mail: info@ilriccio.it
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CUSTOMER NAME: ________________________________________________________
E-MAIL_______________________________

SHIPPING ADDRESS _____________________________________________________________________________________

CITY _____________________________________________________ STATE______________________ZIP______________
COUNTRY ________________________________
PHONE NUMBER ____________________________________________FAX _______________________________________

SEX: MALE / FEMALE
SOCKS USUALLY WORN: THIN / MEDIUM / THICK
CURRENT SHOE SIZE PURCHASED (average): __________________ BRAND ____________________________________
SPECIFY THE MEASUREMENTS SYSTEM: FRENCH SIZE / ENGLISH SIZE / AMERICAN SIZE
OTHER USEFUL INFORMATION __________________________________________________________________________

ITEMS ORDERED
Code                  Art. Name                             Colour & Material                    Item Price      Qty     Total Price
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GOODS TOTAL________________
SHIPPING COST*________________
ORDER TOTAL_______________
Method of payment (make a mark) - Always Prepaid:
Money Order: ___ Wire Transfer: ___ Credit Card: VISA ___ MASTERCARD ___

Card Number: ____________________________________ Exp. Date: ______________ SIGNATURE

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  * Ask for Shipping Cost, Bank Data for Wire Transfer, Confermation of Total Cost, Items, Colours and Materials availability and Delivery Terms.
PRINT AND SEND THIS PAGE WITH THE SOLE SKETCH (RIGHT + LEFT FOOT) enclosing TO OUR:
FAX NUMBER +39-0564-417593
PHASE 1: FOOT LENGHT
(PHOTO 1A, 1B, PICTURE 2)

Left Foot mm.
Right Foot mm.
PHASE 2: the BALL
(PHOTO 2)

Left Foot mm.
Right Foot mm.
PHASE 3: the WAIST
(PHOTO 3)

Left Foot mm.
Right Foot mm.
PHASE 4: the INSTEP
(PHOTO 4)

Left Foot mm.
Right Foot mm.
PHASE 5: the ANKLE
(PHOTO 5)

Left Foot mm.
Right Foot mm.