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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
** Shipping (See Below)
Total Payment
Send a catalog to my friend:
**Shipping Charges
Name:
Merchandise Total
Shipping Cost
Address:
$0.01 - $25.00
$6.95
City, State, Zip:
$25.01 - $75.00
$8.95
$75.01 - $125.00
$10.95
$125.01 and up
$12.95
*2nd Day Service Available for additional $10
*Next Day Service Available for additional $20