Fly Country Outfitters

SHIP TO (If different from above):

Name: _______________________________________________________

Street Address:________________________________________________

City:_____________________________________State:________Zip:_____________Country______________

Daytime Phone: (_____)________________________________________

Preferred Carrier: ( )-UPS ( )-Fed X ( )-US Postal

 Method of Payment:

Check/money order enclosed for the amount of $ ____________________

Credit Card Name:____________ Card Account Number:___________________________________

Expiration Date: _________ Name as it appears on your credit card: ______________________________

Item Description	Qnty	Price Ea.	Total
_________________________________________________	_____	________	______________
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_________________________________________________	_____	________	______________
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_________________________________________________	_____	________	______________
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_________________________________________________	_____	________	______________
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_________________________________________________	_____	________	______________
Subtotal: ______________
Add shipping: ______________
Insurance: ______________
Total enclosed: ______________