J. Seigel Footwear Inc. - Fax Order Form

Fax to: 519-452-9996

Fill out the form below, and then print a copy for your records.
Fax to the above numer, or if you have a modem on your computer, select file--print--select:fax:apply
(You cannot be connected to the internet through a modem ( while on the internet) to fax).

At this time we are only accepting orders from Canada and USA


All orders will be confirmed by e-mail within 2 business days (excluding Sunday/ Monday/ legal & summer holidays). If you do not receive a confirmation please send us an e-mail requesting the status of your order. We have noticed that some faxes have not been received due to incompatabilities of certain fax machines.

E-Mail address:
First Name:
Last Name:
Shipping Address:
Postal Code:
Phone (home):
Phone (work):

Shoe Size: Width:   Colour:
Shoe Style (1) & Brand Name:

Shoe Size: Width:   Colour:
Shoe Style (2) & Brand Name:

Payment Method: Visa Mastercard
Sorry, we can only accept pre-loaded credit cards IN-STORE.

Card Number:        
Card Expiry:   
3 digits at end of card number
on the back of your card
Name on Card:
Issuing Institution
of credit card
(i.e. TD Bank)

Shipping Method:

Click here for
general info

Click for USA
shipping rates

UPS Standard : 3-8 days delivery to most of continental US
(slightly less expensive that Xpost for the US)
Now available for Canada
(closer in pricing to Xpress Post, signature required; no box numbers)
Expedited Post (surface mail) (slower, but trackable for US & Canada
2-10 days Canada
1-3 weeks for US
Not trackable for overseas: 3-12 weeks
Xpress Post ( air mail) (3-6 days delivery to most of US and Canada, 1-4 (?)+ weeks overseas)
Courier (1-3 days, price three to five times regular shipping)
Price to be confirmed prior to processing order.

Please note that although the above shipping times are usually close to described, delays from customs or holiday seasons may delay actual shipment times.
Shipping times are from the time the shipment is released, not when the order is placed.

Note: If the shipping address is not the credit card billing address, please advise the billing address in the boxes below.
You may also use these boxes for other comments, or if there is more than one item being purchased.
All cards are subject to name and address verification by the card issuer.

Please only type within
the white space,
Not beyond.
You can use all 3 lines.

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