The Fly Fishing Shop: Order Form, Page 1

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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