Contact data

First name*

Last name

Adress

ZIP code
Place

e-Mail adress*

Cell/ mobile

Request

Product*
Modifikation deiner High Heels / Modification of your high heels Einlagen für geschlossene Tanzschuhe / Insoles for closed shoes

Mark (f. e. name the measuring person)

Shoes are present*
Nein / No Ja / Yes Kommen per Post / Arrive via mail

Brand
—Please choose an option— Alagalomi Entonces Madam Pivot MUNAY PLUMA Regina Souple Soy Portena TangoLeike Tangolera Werner Kern Andere

Shoe size*
DE/EU UK US

How does the shoe fit?*

Padding at the forefoot?*
Keine / None Blau-Bounce (2mm) / Bounce blue (2mm) Gelb-Umarmung (3mm) / Yellow hug (3mm)

Covering material*
Taupe Natur / Nature Anthrazit / Anthracite Weiß / White Blau / Blue Dunkelblau / Dark blue Braun / Brown Schwarz / Black

Measurement
Liegt vor / Present Gesendet per E-Mail / Sent via e-Mail

Message (optional)

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