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!
