Lighting Store.ca
MANUAL ORDER FORM
Name: Date:
Street Address:
PO Box:
City: Prov/State:
Country: Posal/Zip:
Daytime Telephone:
E-mail:
Payment Method: Check Visa MasterCard
Card Number: Exp. Date: __________ /__________
Signature: Member Number ___________________
 Item # Description: Quantity Price Each Total
      $ $
      $ $
      $ $
      $ $
      $ $
      $ $
      $ $
      $ $
For additional items, please list on a separate page
Subtotal: $
Shipping & Handling:
(Your final shipping cost will be e-mailed to you before your order is processed.)
$
Canadian Residents add 5% GST: $
Order Total: $
NOTES
Please print this page and mail or FAX to the address below.
PO BOX 75083 Westhills RPO, Calgary, Alberta Canada T3H 3M1
FAX: 1.403.229.4293
Call us toll free at 1.877.244.3575 or local: 1.403.686.4290
Visit our Online Store ... CLICK HERE
www.LightingStore.CA