www.luminanti.com

Print, Complete & FAX or MAIL
updated 5-1-08

FAX
919-563-1522

MAIL
Make MONEY ORDER PAYABLE TO:
Anne Christine Tooley
www.luminanti.com
4402 Bradford Ridge Rd.
Efland, NC 27243
NO PERSONAL CHECKS

PHONE ORDER
& Customer Service
919-563-1600
10am - 5pm ET
Monday - Friday
Email: order@luminanti.com
Website: www.luminanti.com

NO PERSONAL CHECKS ~~~ CREDIT CARD or MONEY ORDER ONLY

ORDERED BY Please PRINT Clearly   SHIP TO Please PRINT Clearly

Name____________________________________

Business Name____________________________

Address__________________________________

_________________________________________

City______________________________________

State__________________ Zip Code___________

Country __________________________________

Daytime Phone_____________________________

Evening Phone_____________________________

EMAIL (to send Receipt & Tracking #)

__________________________________________		   Residential Address Yes No

Name_________________________________________

Business Name ________________________________

Address_______________________________________

______________________________________________

City___________________________________________

State__________________ Zip Code_______________

Country ______________________________________

Daytime Phone_________________________________

EMAIL (to send Receipt & Tracking #)

_____________________________________________

Quantity

Description

Unit Price

Total
       
       
       
       
       
       

MERCHANDISE TOTAL

  

Promotional Discount

  -

SUBTOTAL 

  
We calculate the following: NC Tax 6.75% (NC Residents Only), Shipping/Handling/Insurance (S/H/I), and if selected, Express Shipping . We ship UPS Ground. If you want Express Shipping, please circle: OVERNIGHT, 2ND DAY, or 3-DAY (extra charge). A $0.50 handling fee is added to the S/H/I.

Money/Bank Order Enclosed (NO PERSONAL CHECKS) Make payable to: Anne Christine Tooley

Visa Mastercard Discover
CREDIT Card DEBIT Card

Card Number _____________________________________________________ Expiry(mm/yy) ____ / ____

3-digit Security number (CVV2) (on back of card) __________
Name on Card _____________________________________________________________________________
SIGNATURE ____________________________________________ Today's Date______________________
EMAIL (required) Where we send your RECEIPT & Tracking Information:

_________________________________________________________________________________________

CREDIT CARD BILLING INFORMATION
If we do not have this information, your order cannot be processed!

Same as ORDERED BYSame as SHIP TO OTHER (complete info below)

Address _____________________________________ State ____ Zip Code ________ Country _____________