EmailMe Form - Order Form

Your Name

Your Email Address, Hp no.

Orders

01
01-5 (premade size37)
02
03
04
05
06
07
08
09
10(premade size37)
11(premade size37)
12
13
C2
C3
NEW DESIGN

Any requests? (Specific words, name, objects,
colours)

Colours

Shoe type (If more than one order in Q3, may
check more)

Maryjane
Sneaker
Converse shoes

If answered more than 1 shoe type for q6, please
specify:

Which form of payment will you be using?

Paypal
Cash

User Agreement for Custom Shoes

This Agreement is a treaty between you and Black White Rhapsody regarding your order of custom shoes. You must read and agree to all of the terms and conditions written in this Agreement. "BWR, blackwhite Rhapsody" and all logos, services, codes, custom graphics seen on our site are all trademarks of BWR. You may not rip, imitate, copy or use them for commercial uses or personal business without our permission. BWR do not deny that our designs are based on references and graphics found on web, however we have altered and displayed them in such a way that it is our design now. Most importantly, by "checking" this agreement and sending the order form, your order will be officialised, recognized, and you have no right to deny your orders of our custom shoes. Denying of ordering, paying or other actions will be seen as breaching this agreement. You are not required to "check" this agreement.

Shoe size (please see the shoe table)

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EMF Email Form