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 Canadian 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 | ||
