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and send to:
Outdoor World Rod and Reel Repair
2300 East Turner, Suite M
Springfield, MO. 65803

BILL TO: Name of individual paying for repairs.
Name: ________________________________________________ Date: __________________
Address: ________________________________________________________________________
City: __________________________________________________ State/Province: __________
Zip/Postal Code: ____________________ Phone: (_____)___________

SHIP TO: Leave blank if information is the same.
Name: ________________________________________________ Date: __________________
Address: ________________________________________________________________________
City: __________________________________________________ State/Province: __________
Zip/Postal Code: ____________________ Phone: (_____)___________
Repair Information:
Model #: ______________________________________________ Quantity: ___
Description of Problem: _____________________________________________________________

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