Miles Stair's Wick Shop - www.MilesStair.com
For Mail Orders Only, please fill out this form on your computer, print and mail with a
Money Order or Cashier's Check. Personal checks must clear bank before shipping.
Short form.  For other items or overseas orders, please use the long order form.

WICK #

FOR HEATER MODEL

PRICE @

NUMBER ORDERED

TOTAL US$

$

$
$ $
Igniter # See list for exact igniter PRICE EACH # IGNITERS

PRICE   US $

1  Aladdin, Toyotomi, KeroSun $ 4.95

$
3  Corona, Robeson, Sanyo, Heat Mate, DynaGlo $ 4.95 $
ACCESSORIES  
   "Breathe Easy" Catalytic Filter $ 6.95 $

Subtotal for merchandise - US Dollars    

$

          US ONLY      By Amount of Order  - Shipped First Class  

  
US POSTAGE RATES:  $1.00 to $18.00 = $3.95;  $18.01 - $30.00 = $4.95;
$30.01 - $40.00 = $6.85; $40.01 - $60.00 = $8.95;  $60.01 up - $10.95.
(Out of US Postage, go here.)		 $   $
Priority Mail upgrade for orders under $30.00 (US ZIP Codes ONLY) $ 2.00 $

International Order: Use long order form.

TOTAL US $ ONLY 

$
 Your Name
 Your address
 City, State and ZIP Code
 E-mail address

 I will send a Shipping Notice with  Delivery Confirmation number to US destinations with an e-mail address.

 Next day shipping with Cashier's Checks or Money Orders. 
 Please DO NOT send cash or personal checks denominated in non-US funds through the mail!

Send to:   Miles Stair
           PO Box 503
           Coquille, OR USA   97423