River Bottom Lures Order Form

Use your web browser's PRINT command to print out this order form. Fill it out by hand and send it to us by mail or fax.

Sold to: (Street address, not P.O. Box,
required for UPS delivery only)

Name:

Address:



City/State/Zip:		 _______________________

_______________________

_______________________

_______________________

Ship to: (if different from Sold To address)


Name:

Address:



City/State/Zip:		 _______________________

_______________________

_______________________

_______________________

Is delivery address a business or a residence?

Date: __________________________

If we need to call you about your order:
Day Phone No. (      ) ___________________ Evening Phone No. (     ) ____________________


 

 Quantity

 Color and Size

 Price Each

  Total (Price x Quantity)
 1        
 2        
 3        
 4        
 5        
 6        
 7        
 8        
 9        
 10        

Payment:  We accept VISA and MasterCard. Please make checks payable to : River Bottom Lures. Minimum Accessory UPS charge $6.00. Call, fax or email for shipping charges. Please indicate location.

Payment Enclosed Credit Card
 Card#  Exp. Date
 Signature

 Product Total

 Total Shipping & Handling

$8.00
Free Shipping with a $75 order or more

 Subtotal

  

 AR. Sales Tax (Arkansas delivery
addresses only) 9.25%

 
 Total Order  
Your credit card is not charged until we ship your order

River Bottom Lures
3721 Columbia 85 South
Emerson, Arkansas 71740
Voice: 870.547.2915

Send By Fax:
870.547.2900

Send By Email:
Sales@riverbottomlures.com

Thank you for your order!