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Please fill out the information below and mail in this form and the payment
to the address stated. Write checks out to:
Adam Newman
When we have received the payment you will receive a confirmation email.
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Buyer Information
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Name
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Address
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Apt, Suite #
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City, State Zip
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Email Address
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Shipping Information
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Gift (Yes, No)
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Name
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Address
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Apt, Suite #
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City, State Zip
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Package Selection (Check the Box to the Right of
the package you wish to receive)
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6 Flies Per Month For 3 Months - $24.99
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12 Flies Per Month For 3 Months - $44.99
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6 Flies Per Month For 6 Months - $49.99
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12 Flies Per Month For 6 Months - $79.99
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6 Flies Per Month For 9 Months - $69.99
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12 Flies Per Month For 9 Months - $109.99
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6 Flies Per Month For 12 Months - $89.99
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12 Flies Per Month For 12 Months - $139.99
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Fly Assortment Selection (Circle the assortment you
wish to receive and state the quantity)
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Fly Assortment w/Plastic Fly Box & Foam Insert
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One Dozen
$14.99
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Two Dozen
$24.99
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Three Dozen
$34.99
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Four Dozen
$44.99
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Qty:
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Qty:
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Qty:
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Fly Assortment w/Standard Plastic Fly Box
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One Dozen
$12.99
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Two Dozen
$21.99
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Three Dozen
$31.99
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Four Dozen
$41.99
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Qty:
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Qty:
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Qty:
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Shipping Rates
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$0 - $49.99
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$2.50
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$50 - $99.99
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$4.00
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$100 - $100.99
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$6.00
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>$200
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$8.00
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