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Order Form




Please provide quantities of products:

Products:    Warm or Cold White    Quantity
LED STREETLIGHT "Cobrahead" Retrofit Bulb E40      Warm   
Cold   
6W HIGH POWER MR16     Warm   
Cold   
5W LED Bulb     Warm   
Cold   
15W LED Lamp     Warm   
Cold   
10W LED Lamp for commercial lighting     Warm   
Cold   
1W LED Rechargeable Miner's head lamp    Warm   
Cold   
10W LED Downlight Warm   
Cold   

Please provide quantities of products and your client number:

Products:    Quantity    Client Number
4w locomotive screw in LED      
BetterLED  military NF-3V For 2 Cell   
BetterLED bulb   
Screw in base BetterLED bulb   
Red BetterLED bulb   

Please Provide the following contact information:

Contact Name 
Telephone Number 
E-Mail 

Please provide the following shipping and billing information:

Shipping Information: If your billing is different than shipping provide the following information:
Company Name  Address
Address  Address Cont.
Address Cont.  City
City  State/Province
State/Province  Postal/Zip Code
Postal/Zip Code  Country
Country   

Please provide the following billing information if you choose to pay by credit card:

Cardholder Name 
Credit Card 
Card Number 
Expiration Date