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KickBack Customs



Last Updated: 3/28/2008

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Gender: Female
Status: In a Relationship
Age: 20
Sign: Capricorn

City: Livonia
State: MICHIGAN
Country: US
Signup Date: 6/13/2006
Friday, March 23, 2007 
Copy and Paste the following order form outline into a MySpace message or E-mail (KickBackCustoms@gmail.com) and fill in your information!

NAME (FISRT, LAST):

DATE OF ORDER:

PHONE NUMBER:

CITY, STATE:

SHIPPING ADDRESS:

ZIP CODE:

SHOE SIZE:

SHOE ART DESCRIPTION:

FORM OF PAYMENT (PAYPAL(CREDIT), CHECK, OR CASH):

*If you have chosen PayPal, Please include your E-mail address so we can send you an invoice.

E-MAIL ADDRESS:

ADDITIONAL COMMENTS/SPECIAL INSTRUCTIONS:
3:00 AM
 
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