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Miniature World Doll House Shop      ORDER FORM

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Post: Miniature World, PO Box 213, Applecross WA 6913       Fax: (08) 9364 1695


PURCHASER

Name    ...........................................................................

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Address              ...........................................................................

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MINIATURE ORDER
             Items                                                                          Cost

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                                                 Postage & Handling     ...............................

                                                 Total Cost                   ...............................

Other details
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PAYMENT DETAILS

[    ]   Money Order attached     [    ]   Visa     [    ]   Mastercard     [    ]   Bankcard


Amount                     .................................


Credit Card number              ..................................................................      Expiry     __ __ / __ __


Card Holder's Name             ..................................................................


Cardholder's Signature          ..................................................................


                                                      Thank You      

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HOME      www.MiniatureWorld.com.au        Telephone: (08) 9331 7799