M I L L E R D E S I G N S
GAIL BARKER MILLER
18 Fenderson Rd ~ Chebeague Island,
ME 04017
Tel. (207) 846-4369 ~ Fax (207)
846-7747
"PIN OF THE MONTH" ORDER FORM
- Please Mail or Fax this form to the above address/fax number.
| Name _____________________________ |
Date Ordered________________________ |
| Address ___________________________ |
Contact Person ______________________ |
| __________________________________ |
P.O.# _____________________________ |
| Phone/Fax _________________________ |
Terms _____________________________ |
| Month |
Pin & Metal(s)
|
Price
|
| January |
.
|
|
| February |
. |
|
| March |
. |
|
| April |
. |
|
| May |
. |
|
| June |
. |
|
| July |
. |
|
| August |
. |
|
| September |
. |
|
| October |
. |
|
| November |
. |
|
| December |
. |
|
|
TOTAL
|
|
|
LESS
|
10.00
|
|
TOTAL FOR TEN PINS
INCLUDING SHIPPING
|
|
| All shipments outside
the continental U.S. will be billed a $2.00 handling charge and exact shipping
costs. All amounts are for USD (United States Dollars). Please check
your calculations, or, if error is found, we will have to adjust payment/order
for you. Please provide an alternate shipping
address (if necessary) on a separate sheet if you wish to ship the pins
to someone else. One alternate address only please. |
PLEASE INDICATE SHIPPING PREFERENCE
BELOW:
(Indicate by writing "YES" on the
apporopriate space below.)
I would like to have the pins shipped
to the designated address all at once ______ .
I would like to have a pin sent
to the designated address at the beginning of each month _______.
Method of payment:
Check _____ Visa _____
Discover _____ Mastercard _____ AMEX _____
Credit Card #:________________________
Expiration Date: Month ____________
Year __________
Name on Card __________________________________ |