The Miller Concepts Mail Order Form

Print this form from your browser ("File/Print" command or hit Control-P) and mail it to:

Miller Concepts · 7 Cloverleaf Circle · Shubenacadie, NS · B0N 2H0 Canada
Prices in U.S. Funds. Please allow 2-4 weeks delivery. International Money Order required for Non-Credit Card Payments

Name : _________________________________________________________________________
Address: ________________________________________________________________________
City:_____________________ State:____________________ Postal / Zip Code:______________
Country:____________________Tel # : (_____) ___________E-Mail: _______________________
QTY. Item Code Unit Price Total Price
       
       
       
       
       
       
       
       
       
       
       
Sub-Total =====>  
Add: Shipping (please see shipping rate for more information)  
Total Amount Due (International Money Order or check payable to Miller Concepts, please. Thank you.)  

If paying by credit card, please fill in the information as indicated below:
Visa/Mastercard number :  
Expiry Date  
Name on Credit Card