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The Fly Fishing Shop: Order Form, Page 1
Billing and Shipping Information

Print this form and return it by fax (503) 622-5490 or mail to:
Only Online Orders through our shopping cart will be accepted for shipments to foreign destinations. 
FAX , Phone & Mail orders will be shipped to U.S. destinations only.

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 $ _______________________







Credit Card Name (Visa, MC, AMX or Disc.)_______________________________







Credit Card Account Number________________________________________







Expiration Date: __________________________________________________







Name as it appears on your credit card: ______________________________







Order Form, Page 2: Order Information


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