Order Form

Please fill out the following information and press the SUBMIT button


Name
Company
Address1
Address2
City
State
Zip
Telephone
Fax
Email
Item
Quantity
Price
Item
Quantity
Price
Item
Quantity
Price
Shipment*
Credit Card
Expiration
Notes/Comments
*Methods of shipment are Priority Mail, UPS or Federal Express. USPS Priority Mail shipping in the fifty United States is $4.95 for a one pound package while UPS and Federal Express rates vary according to your zip code. If you choose Federal Express without specifying a service we will use Priority Overnight service. If you choose UPS without specifiying as service we will use Ground service.  Please refer to our International Shipping Information prior to placing orders outside of the USA.

**We accept Mastercard, Visa and American Express when ordering with the online order form. If you are using Visa please add the last three numbers from the back of your card to the expiration date. Your credit card statement will show a charge from "Replacement Light Bulbs" of Greensboro, North Carolina.