===============================================================================
                                  ORDER FORM
                                   MAIL TO: 
                             TOOTSIE'S DANCE SHOES
                              9802 W. 125th Terr. 
                           Overland Park, Ks  66213
                   Phone - (816)808-0099 ** Fax - (913)239-9271
===============================================================================
   Ship To:

     Name:__________________________________________________________________
 
     Address 1:_____________________________________________________________

     Address 2:_____________________________________________________________

     City:___________________________State:___________________Zip:__________

     Daytime Telephone# (Required): (______)_______-_____________
===============================================================================
===============================================================================
    |   SHOE             |LEATHER/|      |    |       |HEEL  |        |ADD'L  |
QTY.|   STYLE (NAME)     |FABRIC  |COLOR |SIZE| WIDTH |STYLE | PRICE  |CHARGES|
===============================================================================
    |                    |        |      |    |       |      |        |       |
____|____________________|________|______|____|_______|______|________|_______|
    |                    |        |      |    |       |      |        |       |
____|____________________|________|______|____|_______|______|________|_______|
    |                    |        |      |    |       |      |        |       |
____|____________________|________|______|____|_______|______|________|_______|
    |                    |        |      |    |       |      |        |       |
____|____________________|________|______|____|_______|______|________|_______|
    |                    |        |      |    |       |      |        |       |
____|____________________|________|______|____|_______|______|________|_______|
                                                               |              |
                                                    SUBTOTAL   |______________|
                                                               |              |
  PAYMENT METHOD:                 _____            SALES TAX   |______________|
                                 |     |                       |              |
  CHECK OR MONEY ORDER ENCLOSED  |_____| SHIPPING & HANDLING **|______________|
                                 |     |                       |              |
  Credit Card                    |_____|         ORDER TOTAL   |______________|
     *Must call to use a credit card.                                         

Please Double Check your Order!

** Sub Total includes shoe prices plus any additional charges. 
** Please call if you have questions on additional charges for extras. 
** Kansas Residents - 7.525% sales tax (7.525% OF SUBTOTAL) 
** Shipping and Handling - Shoes - $8.00 first pair, $3.00 each additional pair.
                           Boots - $9.00 first pair, $4.00 each additional pair.
** Fax, call or mail-in orders, To assure accuracy, fill out the applicable portions
   of this form.

                                 THANK-YOU FOR YOUR ORDER!
===============================================================================