Peerless Reel Co. : Fax Order Form

PEERLESS REEL CO.

PEERLESS REEL ORDER FORM

MODEL	DESCRIPTION	QTY	COST	EXT. COST
Model 1A	2 3/4" Traditional Fly Reel		$649.00
Model 1.5A	3" Traditional Fly Reel		$649.00
Model 2A	3 1/4" Traditional Fly Reel		$649.00
Model 3A	3 1/4" Traditional Fly Reel		$649.00
Model 77	2 1/2" Raised Pillar Fly Reel		$649.00
Model 7M	2 3/4" Raised Pillar Fly Reel		$649.00
Model 4A	4 1/2" Spey Reel		$729.00
Model 5A	3 1/4" Salmon Reel - Vom Hofe Drag		$929.00
Model 6A	3 1/2" Salmon Reel - Vom Hofe Drag		$929.00
Total

Shipment are made via UPS Ground Prepaid (Please Inquire for Air or Foreign Country Shipping Charges).     Payment By : MasterCard/Visa

CC Number:____________________________________Exp:___________Security Code:___________
Side Wind (Left or Right Hand): _____________________________________
Signature: ________________________________________________

Ship To
Name: ____________________________________________

Address____________________________________________

City _______________________________Zip______________

Fax to: 603-595-2458   or Mail to:

                        Peerless Reel Company, Inc.

                        P.O. Box 783

                        Nashua, NH 03061-0783