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Miller Concepts · 364 East 11th Street · North Vancouver, BC · Canada V7L 2G9
or fax to : (604) 984-6323
All
orders in U.S. Funds
only Please allow 4-6 weeks
for delivery
| Ship to: | _____________________________________________________________________________ | ||||
| Address: | _____________________________________________________________________________ | ||||
| City: | ________________________ | State: | _________________________ | Postal Code: | ___________ |
| Country: | _________________________ | Your E-Mail: ________________________________________ | |||
| QTY. | ITEM CODE | Unit Price | Total Price |
|---|---|---|---|
| Sub-Total =====> | |||
| Less: Applicable Discounts (please specify what) | |||
| Shipping & Handling ($4.00 + $0.50*Total # of Plates) | |||
| Total Amount Due (Please issue a check payable to Miller Concepts. Thank you.) | |||
| Visa Card Number: | Expiry Date | ||
| Name on Credit Card | |||