Innerlight Lamps, & Shades Order Form
Lamp shades and bases are sold separately!
No Sales Tax! & a $15.00 discount/credit towards your shipping!
SHADES!
Small Shade: size 6" x 15" x 11"	Style:___________ $63.50
	Style:___________ $63.50
Large Shade: size 7" x 17" x 12"	Style:___________ $78.00
	Style:___________ $78.00
BASES!
Sassafras Stick Base: 17 1/2" to socket SSB01	Style:___________ $78.00
Barnwood Base: 22" to socket BWB01	Style:___________ $78.00
Bundled Base 17 1/2" to socket (3 sassafras sticks bundled together w/jute at the top and bottom)	Style:___________ $78.00
TOTAL ORDER:	$_______________________
-$15.00	($ 15.00)
off towards your shipping!
TOTAL(after shipping calculated):	$_______________________
Total shipping fees to be determined after order is placed; we will email you or phone you with the total amount for your order!
Name:_____________________________
Address:_____________________________
City:_______________ State:_________ Zip:____________
Phone:____________________ Email:____________________
Credit Card Number:__________________________________
Expiration Date:______________
Name as on the card: _______________________________________
To order print this form, fax it to us or mail with a check Mail Order Form: Innerlight Lampshades 1753 North 10th Street Springfield, Oregon 97477 You may also inquire and contact us by phone or email: voice 541-747-3436 |    fax 541-345-3665 |   info@innerlightlamps.com