Metallium Mail-Order Form

Metallium Mail-Order Form
P.O Box 79097
Waverley, MA 02479
(508) 789-4464

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Name:	__________________________________________________
Street Address:	__________________________________________________
City, State & ZIP:	__________________________________________________
*Telephone No.:	__________________________________________________
*Email Address:	__________________________________________________
*How did you hear about us?	__________________________________________________

*-Not Required but helpful!

Item Description	Quantity	Price
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___________________________________________________	_______	_______

Sub Total:	_______
SHIPPING/HANDLING ($4.00 per order unless indicated otherwise):	_______
TOTAL:	_______

Please include payment by check or money order, payable to Metallium, Inc.

Send this form and payment to:

Metallium, Inc.
P.O. Box 79097
Waverley, MA 02479

We also accept major credit cards over the phone. Call 508-789-4464 to order by credit card.

Thank you for your purchase!