Please print out this form, fill it in legibly, and fax your order to us.
If you prefer, leave your credit card info off and we will call you for it.

 To: Tim's Seafood, Kirkland, Washington
Fax: 1-425-827-0196

Please include the following information for us:

   NAME:___________________________________________________________________

ADDRESS:___________________________________________________________________

CITY / STATE / ZIP:________________________ / __________ / ________________

PHONE NUMBER TO CONTACT YOU IN CASE OF PROBLEMS:(_______) _______-_________

CREDIT CARD TYPE: [ ]VISA [ ]MASTERCARD [ ]DISCOVERCARD [ ]AMERICAN EXPRESS

CREDIT CARD NUMBER:________________________________________________________

      NAME ON CARD:________________________________________________________

BANK NAME ON CARD:_________________________________________________________

SIGNATURE:_________________________________________________________________


     ITEM               POUNDS          $$ / POUND        TOTAL

1_______________________________________________________________________

2_______________________________________________________________________

3_______________________________________________________________________

4_______________________________________________________________________

5_______________________________________________________________________

6_______________________________________________________________________

7_______________________________________________________________________