MAIL ORDER FORM

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MAIL TO:  HISTORICAL MINIATURES, P. O. Box 903, Lexington, VA  24450-0903

Email: hm@histomin.com             Website: www.histomin.com

NAME:                                                                                  PHONE:

ADDRESS:                                                                            EMAIL:

CITY:                                                      STATE:                 ZIP:                         DATE:

Note: Numbers in parenthesis refer to explanations. Click Here for Help.

No.

Item # (1)

Description (2)

Price (3)

1.

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2.

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3.

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4.

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5.

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6.

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7.

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8.

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(4) ORDER SUB TOTAL

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(5) less ALLOWANCES

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(6) SUB TOTAL

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(7) SHIPPING (CLICK HERE)

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(8) NET ORDER VALUE

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(9) less CREDITS/DISCOUNTS

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(10) SUB TOTAL

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Your Ck/Mo # __________

(11) VIRGINIA RESIDENTS ONLY SALES TAX (5.3%)

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(12) TOTAL AMOUNT DUE

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Make check or money order payable in U.S. funds to "Historical Miniatures"

HM Form 1006 23 Oct 2002
Copyright by George Grasse