Lamps Beautiful Fax Order Form

527 N Azusa Ave #399

Covina, CA 91722

Phone: 626-915-0888 or 866-339-5060

Print out this page, fill in your Name, Address, Phone Number, Items being ordered, Shipping, Sales Tax (CA residents), and credit card information, and FAX to 626-915-0883.

Today's Date:

BILLING ADDRESS As Appears On Your Credit Card:

Name:
Address:

City:

State:

Zip:

SHIP TO: (Must be a street address; we cannot ship to P. O. boxes)

Name:
Address:

City:

State:

Zip:

Daytime Phone in case we have a question about your order (Include Area Code):

Credit Card Number:

Expiration Date Month and Year:

Quantity	Description and Model Number	Price Each	Total Price

SHIPPING & HANDLING CHART

Subtotal up to $25.00 . . . . Add $8.95

$25.01 to $45.00 . . . . . . . Add $10.95

$45.01 to $65.00 . . . . . . . Add $12.95

$65.01 to $85.00 . . . . . . . Add $14.95

$85.01 to $100.00 . . . . . . Add $16.95

$100.01 to $150.00 . . . . . Add $17.95

$150.01 and up . . . . . FREE SHIPPING (Continental US Only)

Call for information on Express Shipping

Allow three to four weeks for delivery.

Merchandise Subtotal

Shipping & Handling (See Chart)

Sales Tax (CA residents)

TOTAL

Thank you for your order!