Back to Order Information Page       Print this Order Form to Mail or Fax Your Order

Fax to:  903-223-9143                  Mail to:  Lynn & Barton * 4 Shadow Dr * Texarkana, TX  75501-9520
                                                      Make checks and money orders payable to:  Lynn & Barton

Quantity     Item Description                                                                  Color/Style

     
     
     
     
     
     
     
     

Email Address______________________________________ Confirm Email Address______________________________________

Day Phone _______________________ Evening Phone _______________________ Shipping to:  ___Commercial Address   ___Residential Address

Shipping Information

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Recipient's Name

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Business Name (if applicable)

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Street Address
Be sure to include apt or suite no if applicable

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City, State, Zip Code

 Billing Information      _____same as shipping

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Recipient's Name

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Business Name (if applicable)

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Street Address
Be sure to include apt or suite no if applicable

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City, State, Zip Code
 Delivery Charges - orders normally delivered within 2 to 5 business days.
           $5.95 - Bulb only orders less than $25.01
          $9.95 for orders up to $50.00
        $12.95 for orders over $50.00 & up to $100.00
        $15.95 for orders over $100.00 & up to $150.00
        $18.95 for orders over $150.00 & up to $200.00
        $21.95 for orders over $200.00 & up to $250.00
  		         $24.95 for orders over $250.00 & up to $300.00
        $27.95 for orders over $300.00 & up to $350.00
        $30.95 for orders over $350.00 & up to $400.00
        $33.95 for orders over $400.00 & up to $450.00
        $36.95 for orders over $450.00 & up to $500.00
        $39.95 for orders over $500.00

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Master Card or Visa Number (16 Digits)                                               Credit Card Expiration Month / Year

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Signature of Card Holder                                                                  Date