Miller Media Vision Order Form
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Miller Media Vision, LLC
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www.millermediavision.com
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248-345-6741
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PLEASE PRINT CLEARLY
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Student Name:

Check #:
Cash:
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Address:
City:
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Phone:Email:
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Packages
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Package 1 - $25Package 2 - $30
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QuantityItem
Quantity
Item
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1
Button
2
Button
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25 x 725 x 7
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18 x 1018 x 10
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Wallets (w/ name and year)
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Orders
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Packages
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ItemsCost
Quantity
Total
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Package 1 $ 25.00
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Package 2 $ 30.00
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Individual Items
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Wallets $ 3.00
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Buttons $ 3.50
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5 x 7 $ 10.00
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8 x 10 $ 20.00
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11 x 14 $ 30.00
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Statuettes (5x7 individual)
$ 25.00
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Statuettes (8x10 individual)
$ 35.00
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Final Total:
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All checks returned will be assessed a $20.00 fee and orders will be delayed.
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Orders filled out incorrectly will be delayed in processing.
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Percentage of all the orders will be donated back to the band boosters.
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Miller Media Vision
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27437 Pond Drive
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New Hudson, MI 48165
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