lights_order

Lumina Display Lights Fax Order Form

Contact Information
Contact		Company
Address		Suite
City		State/Zip
Phone		Fax
Email
Ship To Address (If different)
Contact		Company
Address		Suite
City		State/Zip
Phone

Credit Card Information
Card Number		Exp. Date
Exact Name		Billing Address
City		State/Zip

Quantity	Description	Price	Total
	Lumina 200 W Wall Washer Light	$145.00
	Lumina 75 W Wire Form Light	$125.00
	Lumina 50W Halogen Light	$85.00

Prices Include Ground Shipping from Wilmington, NC; Call for 2nd Day or Next Day rates.

California Sales Tax will be added for shipments to California. Thank you for your order.
We will confirm your order with the totals and shipping date by E-Mail to the above address.

Your credit card will be billed by Easydisplays when the order is shipped.

Please print out this form and fax it to (714) 464-4297, email PDF to mac@easydisplays.com,

or call (800) 791-8852 (USA toll free) if you wish to place an order by phone.

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EasyDisplays, 100 S. Sunrise Way, Suite A-902, Palm Springs, CA 92262