Product Checklist


Please print this form and fill out the following information. Include this order form with your repair order.

Fortuna's
7835 Woodmont Ave.
Bethesda, MD 20814

If you should have any questions, please call us at (301) 654-2533 or e-mail us.

Date:_______


Customer:______________________________________________


UPS Address:___________________________ Apt./Ste:______


Business Name:_________________________________________


City:__________________ State:______ Zip:______________


Work Number: (___)-___-____ Home Number: (___)-___-____


Payment Information: Check__ Visa___ Master Card___


Card Number:__________________ Expiration Date:________



Signature:________________________

Please select the items and quantities you would like to order. We will email you the total cost before shipping!

$6.95each

Quantity:___ Barge Cement    

                                     
                                                                 $8.95each
Quantity:___ Desalter
Quantity:___ EZ Cleaner
Quantity:___  Apple Leather Care
Quantity____ Apple Leather Cleaner
 Quantity____ Apple Suede and Nubuck Cleaner
 
Quantity:___ Shine Brush        $9.95
Quantity:___ Shine Cloth         $4.95
Quantity:___ Shoe Laces        $2.95 (Color_______)

Quantity:___ Spot Remover  $8.95
Quantity:___ Suede Renew   $8.95(Color_______)
Quantity:___ Suede Stone     $6.95

Quantity:___ Tinted Polish     $6.50(Color_______)

Quantity:___ Apple Garde Rain and Stain Repellent  $10.25

You may order Apple Products Thru Google Checkout!



Send it to Fortuna's


 
 

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