A.E. Miller Manufacturing -- Internet Fax-In Order Form

Order Form

1. Please print this blank form for future orders.

2. Fill out the form completely. Don't forget to include your telephone number.

3. Fax in the completed form to us 24 hours a day - 7 days a week.

4. Your order will be filled quickly.

5. Or you can mail the form to the address above.

6. If you wish to go back to our site, please click here to go to Quality Craft Cross Roads.

Name:___________________________________

Company:________________________________

Street Address:____________________________

City:_________________State:____Zip:________

Phone:___________________________________

Fax:_____________________________________

E-mail:__________________________________

Method of payment: [ ] MC [ ] Visa [ ] Check

Card #:__________________________________________

Exp. Date:________________________________________

Signature:_________________________________________

[ ] Please bill 30 day terms (Businesses with pre-approved credit.)

[ ] Please ship C.O.D.

Order Date:_______________________________________

Shipping charges will be added.

Please specify preferred shipping method.

Subtotal :_____________

Iowa residents add 5% sales tax :_____________

Shipping and Handling :_____________

Total Amount :_____________