Order Blank

Please print this form

Mail and Fax Order Blank

How to order:
1. Fill in the order blank as indicated.
2. Order the same size moccasin as regular shoe size. Some styles are not made in half sizes. In this case, order the next full size.
3. Include Check, Money Order, or Credit Card Information. No COD's.
We will pay the postage on 2 pair or more to one address in 48 lower states. Otherwise add a one time per order charge of $4.99 to cover the cost of postage and handling.

4. Mail or Fax to:
Seguin's/Moccasins, W1968, Highway 41, Marinette, WI 54143

 Fax: 1-715-735-3824

Billing Information
NAME _______________________________________
EMAIL _______________________________________
STREET______________________________________
CITY ___________________STATE ____ ZIP ________
PHONE ______________________
Gift Information
NAME _______________________________________
STREET _____________________________________
CITY __________________STATE ____ ZIP _________
PHONE ______________________
Qty. Cat. No. Description of Item Size Color Price
x x x x x x
x x x x x x
x x x x x x
x x x x x x
x x x x x x
x x x x x x
Sub Total x
Wisconsin residents add 5% sales tax x
Postage and handling: Free 2 pairs, Single pair purchase                                    add $4.99 x
Total amount enclosed x

(  ) Check (  ) Money Order (  ) Mastercard, (  )Visa, (  ) Discover (  ) American Express


Account Number __________________________ Exp. Date___________

CVV Code. The last three/four digits on your signature strip.
Required for Visa, Mastercard and American Express cards.  _______