Print This Page
Murray's Fly Shop Order Form Date ______________
121 S. Main Street Email: info@murraysflyshop.com
P.O. Box 156 Phone: 540-984-4212
Edinburg VA 22824 Fax (540) 984-4895 
Phone (540) 984-4212
Billing Address Shipping Address (___) Check here if same as billing
Name:
Name:
Address:
Address:
City, State, Zip:
City, State, Zip:
Daytime Phone:
 Method of Payment: (Check One)
Email Address:
 (__) Check (__) Money Order
  (__) Visa (__) Mastercard
Credit Card Number:
Expiration Date:
CCV2 (last 3 digits on back of card): ___________
Quantity Color/ Size Item Cost/ Each Total

 

 

 
Please continue order on back.
Total for Front Page
 
In event of stock shortage would you prefer?
Total from Back Page
 
__ Substitute Color, Size or Equiv. Item
Total of Front and Back
 
__ Hold for Backorder
VA Sales Tax 5% (VA Residents Only)
 
__ Issue Refund
** Standard Shipping (See Below)
 
__ Add to monthly newsletter using email listed
Express or Overnight Charge?
 
 
Total Payment
 
Send a catalog to my friend: **Shipping Charges (Standard 2-7 days)
Name: Merchandise Total Shipping Cost
Address: $0.01 - $25.00 $5.95
City, State, Zip: $25.01 - $50.00 $7.95
Orders are shipped via UPS or USPS $50.01 - $75.00 $9.95
Other Options: $75.01 -$100.00 $10.95
Express (2-3 business days) available for extra $9.95
$100.01 - $150.00 $12.95
Overnight-next business day delivery available for extra $22.90 $150.01 - $200.00 $14.95
  $200.01 - $300.00 $16.95
  $300.01 and over $18.95