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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