Mail Order

Order Form

Name______________________________________________________________

Address ____________________________________________________________

City______________________________ State ________ Zip ______________

Email________________________________ Phone ______________________

_________________ FlyReelDot _________________ CaseDot # Packs_______

FlyReelDots Ordered _____ x $4.99 Ea = _______

CaseDots Ordered _____ x $4.99 Ea = _______

TOTAL FOR ALL PRODUCTS _______

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

Shipping & Handling $4.00

Grand Total __________

Make checks payable to Brumfield Enterprises

Mail to:

Jerry Brumfield
Brumfield Enterprises
1625 WarPath Road
West Chester, PA 19382