Phone (in case any questions
about order)
(__________)_____________-_________________
ORDER FORM
Print out this order form using the <Print> button on your browser.
Order by Phone 24 HOURS: 719-636-2703 or E-mail: mark@rothangling.com
SEE [HOW TO ORDER] FOR ORDERING INSTRUCTIONS & ORDERING INFORMATION
ROTH ANGLING ~ PO Box 38103 ~ Colorado Springs, CO 80937
Ship to: Ordered by: (if different than ‘ship to’)
Name____________________________________________________ Name___________________________________________
Address__________________________________________________Address_________________________________________
City_________________________State_____ ZIP __________ City_________________________State______Zip____________
Visa/MC#_________________-_________________-_________________-_________________ Exp. date ________/________
Phone (in case any questions
about order)
(__________)_____________-_________________
Signature (for credit card orders) _____________________________________________________________
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Fly Pattern |
Color |
Qty/size | Qty/size | Qty/size | Qty/size | Qty/size |
Price Each |
Total |
| 1. | $ | $ | ||||||
| 2. | ||||||||
| 3. | ||||||||
| 4. | ||||||||
| 5. | ||||||||
| 6. | ||||||||
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| 11. | ||||||||
| 12. | ||||||||
| 13. |
Flies
|
Fly Pattern |
Color |
Qty/size | Qty/size | Qty/size | Qty/size | Qty/size |
Price Each |
Total |
| 14. | ||||||||
| 15. | ||||||||
| 16. | ||||||||
| 17. | ||||||||
| 18. | ||||||||
| 19. |
Fly Plates/Shadowbox Kits/Custom Framing:
| Item # | Item Description | Size | Frame | Mat Color | Price Each | Total |
| 20. | ||||||
| 21. | ||||||
| 22. | ||||||
| 23. | ||||||
| 24. |
| SUBTOTAL | $ |
| SHIPPING | |
| ORDER TOTAL | |
| SALES TAX: Colo. residents add 3% to total | |
| TOTAL ENCLOSED | $ |
(Customer comments/instructions)
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