HOME         Mail Order: BacklashSportfishingUSA.com     Print this page.
32 Williams Avenue, Deptford NJ 08096 
Fax: 1-856-000-0000     Order By Phone: 609-820-6226
Please type or print!
Date:
Phone: (     )
   
CREDIT CARD INFORMATION:
CC Type and Number:
Name on card:
Card Billing Address:
Expiration Date:
Total # of Products Ordered:
Discount ID# and %:
Sales Tax:
US Mail Shipping Cost:

Additional Info:
(enter here)


  
Name: OFFICE Use Only:
Deliver To Address: Out of Stock Item#:
   
City: Special Instructions:
State: Zip: Code: Other:
Your Email Address:   [  ]   Add me to your Mailing List
All Shipments Require Payment In Full: Provide Credit Card information for fastest service. Money orders and checks may be mailed to the address above following Order Confirmation via email.
* Additional Space.



  [  ]   Fax Back my Order Confirmation

NO minimum order. For additional Items simply print additional order form.

Print, Enter Product Information, and call to 609-820-6226 for FAST Ordering.

We will verify your Complete Order and Total Cost including S/H to you via Email.

Description Price per
Item
Quantity Shipping
Total
           
           
           
           
           
           
 

Total Amount of Order

 
 

NJ State Sales Tax 7.0%

 
 

Total Shipping Cost

 
 

Total Enclosed

 

Check here to authorize actual delivery amounts to be applied to Credit Card: [  ]
Backlash sportfishing mail in order form Shipping Costs for Standard Shipping:
Purchase Amount - Shipping Cost
Up to $50.00 $5.95
$50.01 - $99.99 $7.95
$100.00 - $199.99 $9.95
$200.00+ - FREE Shipping
NOTE: For all over size items please call for shipping costs
For Next Day, please add $15.00
For 2nd Day, please add $10.00
For 3rd Day, please add $5.00

Thank you for your order! We appreciate your business. - backlashsportfishingusa.com

Copyright 2007 Millennium Internet Development - Patricia Greene, www.Midco2000.com

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