Product Checklist

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

7835 Woodmont Ave.
Bethesda, MD 20814

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



UPS Address:___________________________ Apt./Ste:______

Business Name:_________________________________________

City:__________________ State:______ Zip:______________

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

Payment Information: Check__ Visa___ Master Card___

Card Number:__________________ Expiration Date:________


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


Quantity:___ Barge Cement    

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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