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MAXIS
MINIS order form
www.maxisminis.com
Please Print
Send Order to:
Name________________________________
Max Fields
Address______________________________
182 N. Walnut Dr.
State &
Zip___________________________
Greenfield, IN 46140
Phone
#______________________________
e-mail:
max@maxisminis.com
e-mail________________________________
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Method of Payment |
Merchandise Total |
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Sorry no C.O.D,'s |
FREE POSTAGE |
00 |
00 |
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O
Check or Money Order Payable to
Max
Fields
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Indiana
Residents add 6%sales tax |
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| Visa Master Card
Discover American Express |
TOTAL |
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| Card # _____ _____ _____
_____ |
| Expiration Date______/______ |
| Name on Card |
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Please Print |
| Signature: |
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