Brumfield Enterprises Mail Order Form

Name______________________________________________

Address ____________________________________________

City__________________________ State  _____   Zip________

Email__________________________  Phone_______________

Dot____________________________       # of Packs_______

Dot____________________________       # of Packs_______

Dot____________________________       # of Packs_______

Dot____________________________       # of Packs_______

Dot____________________________       # of Packs_______

Dot____________________________       # of Packs_______

Total FlyReelDots Ordered   _____x $4.99 Ea = ____________
Total CaseDots Ordered       _____x $4.99 Ea = ____________
Total EarRingDots Ordered   _____x $4.99 Ea = ____________

ZipCast...................................$9.95/Bottle   # of Bottles ______
Fly Tyer’s Finger Treatment.... $6.95 each     # Ordered   ______
Hand & Palm Treatment..........$5.95 each     # Ordered   ______
Magnetic Rod Guard...............$8.59 each     # Ordered   ______
20/20 Tippet Threader............$10.00 each    # Ordered   ______
Magnetic Fly Guard.............. .$10.59 each    # Ordered   ______
ZDO Feather/Craft Bags.........$5.99 each      # Ordered   ______
TOTAL FOR ALL PRODUCTS                                 ___________

PA Residents add 6% sales tax (.06 x Total)             ___________

USA Shipping & Handling                                               $3.00
International Shipping & Handling                                 $7.95

Grand Total                                                              ___________