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CHECKS PAYABLE TO:
Jim Vincent
Address Light Store

380 N. Keyser Ave.

Scranton, PA. 18504

 

Qty.             Model#                           Unit Price            Total

 

____                #1001                                      $__________              $___________

 

____                #1002                                      $__________              $___________

 

____                #1003                                      $__________              $___________

 

____                #1004                                      $__________              $___________

 

____                #1005                                      $__________              $___________

 

____                #1006                                      $__________              $___________

 

____                #1007                                      $__________              $___________

Print out this form 

& mail order today!

 

 

                                                            Sub-Total                                        $___________

 

                                                            Sales Tax                                        $___________

 

Shipping & Handling                        $___________

 

Total Order                                     $___________

 

 

Send Check or Money Order to above address.

 

Name___________________________________________

 

Address_________________________________________            

 

City____________________State______Zip___________

 

Phone#_________________________________(So we can finalize order)

 

E-Mail_________________________________

 

 

Thank You for your order!