Northwest Bass, LLC

P.O. Box 825

Veradale, WA  99037

(509) 499-8797

Solar Bat Sunglasses Order Form

Customer Name: __________________________________

Shipping Address: ______________________________________

                             ______________________________________

                             ______________________________________

Phone Number: _______________________

____:  Ship directly to customer at above address ($10.50 charge)

____:  Hold for pickup from Northwest Bass at next tournament (no charge)

Payment Enclosed: _____    -or-

Credit Card No: _______________________   Card Type: Visa / MC / AX / Discover

Billing Address (if different from shipping):

                             _____________________________________

                             _____________________________________

                             _____________________________________

Home Phone Number (if different from above): ____________________

Signature: ________________________________

You may phone, email, or mail in your order to Northwest Bass.

* R_X orders must include a hard copy of current prescription.