| FISHING TACKLE PLUS™ | |||||||||||||
| 1600 Laurel Road #A6 | |||||||||||||
| Lindenwold, NJ 08021-6747 | Date | ||||||||||||
| Billing address: | Shipping Address: | ||||||||||||
| NAME | NAME | ||||||||||||
| ADDRESS | ADDRESS | ||||||||||||
| CITY, STATE, ZIP | CITY, STATE, ZIP | ||||||||||||
| PHONE | PHONE | ||||||||||||
| ITEM NO. | DESCRIPTION | QTY | PRICE EA. | TOTAL | |||||||||
| Delivery Charges | Merchandise Total | ||||||||||||
| For orders within the Continental US | Shipping (see chart) | ||||||||||||
| USPS Priority Mail | SUB TOTAL | ||||||||||||
| Merchandise Total | Shipping Cost | NJ residents add 6% | |||||||||||
| $0-$9.99 | $7.95 | Order Total | |||||||||||
| $10-$49.99 | $9.95 | ||||||||||||
| $50-$99.99 | $11.95 | Mail this form to the address above | |||||||||||
| $100-$199.99 | $14.95 | or fax to 856-627-2689 | |||||||||||
| $200 & over | FREE | ||||||||||||
| INSURANCE: | Free for domestic shipments | ||||||||||||
| Required information for credit card payment: | |||||||||||||
| Indicate Payment Method: | E-mail: | ||||||||||||
| _____ Money Order | Home telephone: | ||||||||||||
| _____ Cashier's Check | Card type: | ||||||||||||
| _____ Personal Check | Card #: | ||||||||||||
| _____ Credit Card | Exp: | ||||||||||||
| CVN: | |||||||||||||
| NOTE: you must have a valid e-mail address | |||||||||||||
| to pay by credit card | Signature: | ||||||||||||
| Your name as it appears on the card: | |||||||||||||