Dr. Miriam Claude Meijer’s

          You cannot order online, but you can type your answers before printing the form and JavaScript will check if you forgot any required information and calculate prices for you. Click the “CREATE PRINTOUT FORM” button below and mail that form with an enclosed check or money order payable to “Miriam Meijer” (in U.S. funds drawn on a U.S. bank), or with the Visa or MasterCard credit payment information handwritten on the printed form, to Dr. Miriam Meijer; c/o DANCO; 929 Gist Avenue; Silver Spring, MD 20910-4944     USA
          Our Refund Policy can be obtained when you click the “Refund Policy” button below; it is also printed on the bottom of your Printout Form. Should you fill this form out by hand, please print all of your answers clearly. Thank you for your order.

The fields with an asterisk (*) are REQUIRED.  Use your “Tab” key to jump to the next field. Orders with an email address will be notified of shipment date!
I prefer to pay in Euros.

   NAME* 
 Company 
ADDRESS* 
 Address 
   CITY* 
  STATE* 
    ZIP* 
 Country 
  PHONE* 
     fax 
   email 

STEP 1. Type the number of books in the Quantity box and then click outside the box:

Subtotal

STEP 2. Select State and then click the Calculate Total button (you must click this button again after any changes you make):

Shipping & Handling

Enclose a check payable to “Miriam Meijer” in U.S. funds drawn on a U.S. bank with order form.
     Or select card type, type the cardholder’s name, expiration date, and enter the rest of your Credit Card information only after clicking the “CREATE PRINTOUT FORM” button below. As a precaution from Spyware, we are not having you type any sensitive information with keystrokes. Please print the numbers neatly by hand on the form that you mail to us.

Visa	MasterCard
Name on Credit Card:
Expiration Date: mm 01 02 03 04 05 06 07 08 09 10 11 12	Expiration Year: yyyy 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2029
Please sign at “Cardholder’s Signature” on the “Mail-In Book Order From” that you can print and mail after clicking the “CREATE PRINTOUT FORM” button. Otherwise, sign below: Customer’s signature is required to process any credit card payments.
Hand print Card Number: [  ] [  ] [  ] [  ]-[  ] [  ] [  ] [  ]- [  ] [  ] [  ] [  ]-[  ] [  ] [  ] [  ]
Hand print CVN code: [  ] [  ] [  ] [  ] (The Card Verification Number is the three or four digit number located on the back of your credit card. It’s the last set of numbers, and is typically located on the signature strip.)

Mail to:

Dr. Miriam Meijer

c/o DANCO

929 Gist Avenue
Silver Spring, MD 20910-4944      USA

For example, if Shipping Address is different from the Billing Address, enter the Shipping Address here.

Indicate if you prefer to pay in Euros; special arrangements can be made for this.

Your privacy is maintained absolutely: none of your information is shared or released in any way.

Questions?

email: book@petruscamper.com