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The Fly Fishing Shop: Order Form, Page 1

Billing and Shipping Information

Use the "save as text" function of your browser to save both pages of this form, and return it by fax (503) 622-5490 or mail to:

The Fly Fishing Shop
P.O. Box 368
Welches, Oregon, USA
97067


BILL TO:



Name: __________________________________________________________________________________________________







Street Address:______________________________________________________________________________________







City:___________________________________________________________________________







State:____________________Zip:_______________Country_____________________________________







Daytime Phone: _(        )______________________________________________________







SHIP TO (if different than above):



Name:___________________________________________________________________________







Street Address:_________________________________________________________________







City:___________________________________________________________________________







State:__________________ Zip:_______________  Country___________________________







Daytime Phone: _(        )______________________________________________________











Preferred Carrier:  ( )-UPS   ( )-Fed X    ( )-US Postal







Method of Payment:



Check/money order enclosed for the amount of $ _______________._________________







(  )-Visa     (  )-Master Card     (  )-American Express     (  )-Discover







Credit Card Account Number______________________________________________________







Expiration Date: _______________________________________________________________







Name as it appears on your credit card: ________________________________________







Order Form, Page 2: Order Information

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