Miles Stair's WICK SHOP Order Form

Wick Shop Mail Order Form - Short version. For large orders or overseas orders, go here.

Credit card orders - please use the Add to Cart buttons on the web site.
For Mail Orders, please fill out this form on your computer, print, then mail to me.

WICK #	FOR HEATER MODEL	PRICE @	Quantity	TOTAL US Dollars
		$	#	$
		$	#	$
IGNITERS -Specify which (1, 2 or 3) - $4.95		#	#	$
Other		$	#	$
Subtotal for merchandise - US Dollars				$
US POSTAGE per merchandise total above			Add proper postage please
$1.00 to $18.00 = $3.95; $18.01 - $36.00 = $4.95. If higher amount, use long order form.				$
Priority Mail: extra for orders under 13 oz. (US ONLY)			$1.00	$
TOTAL = US$ ONLY = Make check or Money Order to Miles Stair, please. Please DO NOT send cash or personal checks denominated in non-US funds through the mail!)				$

Your Name..................
Your Postal address....
City, State and ZIP Code
e-mail address

----Snip for mailing label----

Miles Stair

PO Box 503

Coquille, Oregon 97423 USA