Form

Please complete the form below and a Sales Representative will contact you via email with your purchaing agreement, sales order, and credit card authorization form (if needed).

Due to high response, please allow 15-30 minutes for our company to respond to your equipment order.

To contact us directly, please call (877) 266-6935 ext. 4. Hours of operation are Tuesday - Friday from 10:00 AM - 5:00 PM CST.

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First Name:*

Last Name:*

E-Mail Address:*

Office Phone:*

Mobile Phone:*

Your City and State:*

How Did You Find Us?*

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Company Name:*

Company Website:

Business Speciality:*

Restaurant Boutique Hotel (i.e. Hotel Derek) Hotel Chain (i.e. Marriott) Conference Center Church Nightclub Bar Other - not listed

Products I Am Purchasing:*

LED Color-Customized Panels (available) LED Bulbs (out of stock) Ellipsoidal Projector (out of stock)

Number of LED Color-Customized Panels (minimum 16 per order / sold in packages of 4)

Number of LED Bulbs (currently out of stock)

Number of Ellipsoidal Projectors (currently out of stock)

Method of Payment:

3 Monthly Installments (Credit Card Only) Pay-in-Full by Credit Card Pay-in-Full by Cashier's Check Pay-in-Full by Company Check

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Questions or Comments:

SUBMIT LIGHTING EQUIPMENT ORDER: