Amfit Insole Re-Order Form

Womens Straight Molded

Type/Size

Medium Qty:

Dual 1 Qty:

Insole Re-Order Form

Amfit customers can place re-orders online through the form below,
or download a PDF for faxing. Note– to use this system, you MUST already
have an account with Amfit.

Download a PDF form for faxing

All items in RED are required:

*Customer/Business Name:
*Order Placed By:
*Order Date (mm/dd/yy):	Ship Date (mm/dd/yy):
*Ship To Address:
*City:	*State/Province:
*Zip/Postal Code:	*Country:

*Purchase Order#

*Ship Via

International

Update Disk

Mens Straight Molded
Type/Size	3-4	5-6	7-8	8-9	9-10	10-11	11-12	12-13	14-15	16-17
Soft Qty:
Medium Qty:
Firm Qty:
Dual 1 Qty:
Dual 2 Qty:

Mens Curve Molded
Type/Size	3-4	5-6	7-8	8-9	9-10	10-11	11-12	12-13	14-15	16-17
Soft Qty:
Medium Qty:
Firm Qty:
Dual 1 Qty:
Dual 2 Qty:

Womens Dress
Type/Size	5-6	6-7	7-8	8-9	9-10	11-12
Medium Qty:
Firm Qty:

Cambrelle
Type	QTY @ 150'
Brown
Blue

Leatherette
Type	QTY @ 150'
Brown