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Shipping Information Name: ________________________________________ Company: ________________________________________ Address: ________________________________________ City: ________________________________________ State: _______________________ Zip: ___________ Phone 1: _______________ Phone 2: _______________ email: _______________________________________ |
| Order Form: | |||||
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| Name of Illumination | Product code | Qty | Price ea. | Total Price | |
| Total for Illuminations | |||||
| California shipping addresses add 8.25% sales tax | |||||
| Total for Delivery Charge (see chart below) | |||||
| Total Amount | |||||
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Currently we can only accept checks and money orders. |
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For wholesale orders, enter your reseller ID here: _____________ |