Milano Music Order Form

You may copy this form and
fax it to:(480) 834-8095 or
fill it out and submit it.

"We understand security issues with credit cards over the web. For your protection and peace of mind you may call our toll free number 1-800-344-9324 to order or please send your credit card information in two e-mails. The first e-mail will have the first 8 digits of your credit card, the second will have the last 8 digits with the expiration date. There will be no tax, but shipping will be added. No order will be shipped without verification from customer with full address and phone number. This form can be your first email then send a second email to: form@milanomusic.com."

Name:
Address:
City:
State:
Zip:
Phone:
Email:
Type of Credit Card:
Credit Card Number:
Credit Card Ex Date:
Name As it Appears on Credit Card:
Description:
Brand:
Stock#:
Milano Price:
Amt Required:
Description:
Brand:
Stock#:
Milano Price:
Amt Required:
Description:
Brand:
Stock#:
Milano Price:
Amt Required: