Verilux SmartLight Handbuch PDF herunterladen (Seite 9)

Component Order Form

Cut Along Dashed Line

Order Online at www.verilux.com/replacement bulb

Mail or Fax your order by using this form to:

Verilux, Inc., 340 Mad River Park, Waitsﬁeld, VT 05673

Fax: 802-496-3105

Quantity Price Order Code Product

$19.95 CFML27VLX 27 Watt Natural Spectrum

Bulb

$6.95 Shipping & Handling

Subtotal

CT & VT Residents ONLY add 6% Sales Tax

Total Payment Enclosed

Payment Method:

❏VISA ❏MASTERCARD ❏DISCOVER ❏AMERICAN EXPRESS ❏CHECK

Name as it Appears on Card

_____________________________________________________________________

Credit Card Number _________________________________________________

Expiration Date ______________________________________________________

Security Code (from back of card) ______________________________________

Authorized Signature (credit card purchasers ONLY)

_____________________________________________________________________

Ship to Address _____________________________________________________

_____________________________________________________________________

Phone Number ______________________________________________________

Email Address _______________________________________________________

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Verilux SmartLight Handbuch Seite 9