ORDER FORM

Mail to: Natural Choice in Lighting 103 Temple Road Temple, Maine 04984
Phone your order to:  (207) 779.0830    (After 5:00 PM. (EST) this phone MAY BE answered by a machine, please leave your Name and Number and best time for US to RETURN your call, or if you prefer, you may leave your order. Don't forget you can fax orders too!
Fax your order: (207) 779.0830 (for ordering ease, print and save this handy order form then mail or fax it!)
E-mail your order to: info@naturalchoicelighting
STYLE NUMBER DESIGN NAME or COLOR SELECTION Are you  ordering
SHADE (s) ONLY		 Are you 
ordering
UNIT 
(lamp & shade) 		 LAMP
SHADE
HARD-
WARE
clip, washer,
uno, chimney, candelabra		 Hand Laced Trim  or (please mark Trad. Trim or
one choice 		 Standard Trim
for each shade ordered)		 Lamp Description Lamp Color Lamp Size How
Many		 Price Each Total
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
Shipping Charges  

Sub Total:

        
$ 00.00-$20.00----$ 6.50 Maine Delivery add 5% Sales Tax:        
$20.01-$ 40.00----$ 7.50 Shipping Charges: (charges at left)        
$40.01-$ 60.00----$ 8.50 Grand Total:        
$60.01-and up------$ 10.00          

Info regarding Privacy Policy, Guarantee, Shipping Policies, etc.

Method of Payment:
Please check one: ______________ ____CHECK/M.O.

ACCOUNT #

EXPIRATION DATE__________________/_____________________
                                            (MONTH)                                  (YEAR)

NAME AS IT APPEARS ON CARD: 
(PLEASE PRINT)

SIGNATURE AS IT APPEARS ON CARD:
(PLEASE WRITE SIGNATURE)

NAME:

STREET ADDRESS:  
 		 STATE: ZIP:

PHONE NUMBER:

E-MAIL:
Privacy Policy, Credit Card Security: Your mailing address, e-mail address, phone number, Credit card numbers, in other words, ANY and all personal information you supply us with WILL NOT be stored online, given to anyone else,  or sold to anyone else, for any purpose, EVER! All information is used strictly in house in reference to your orders, and helping us communicate with you