Southern Lamp: Mail or Fax Order Form 
SOUTHERN LAMP & SUPPLY
4746 US HWY 441S
SYLVA, NC 28779-7135
FAX ORDERS TO:  (828) 631-0287       CREDIT CARD INFO 
        
 Ship To Name: 
 Company Name: 
 Ship To Address:
 City:  State or Province:
 Country: ZIP or Postal Code:
 Daytime Phone: E-Mail Address:
 
 Card Number:    
 Exp. Date: /  CVV2 Code:     Card Type:
 Name on Card: 
 Signature: _____________________________________ Date:
 If BILL TO Address is Different From SHIP TO:
 BILL TO ADDRESS: 
 BILL TO CITY:   BILL TO STATE:  BILL TO ZIP: 
Other: PayPal Email:
Qty. Part # Description Price Ea Total
Total For All Items       
North Carolina Residents Only Add 7% Sales Tax
Add Shipping Charge (see below)
Total For This Order 
              ________________________________________________________
SHIPPING CHARGES-US SHIPMENTS ONLY. HAWAII , PUERTO RICO & ALASKA HIGHER  (INTERNATIONAL ORDERS REQUIRE ADDITIONAL POSTAGE BASED ON WEIGHT/SIZE)
  Total AmountShipping Charges
$0.01-$45.00$  8.00
$45.01-$65.00$10.00
$65.01-$85.00$12.00
$85.01-$105.00$14.00
$105.01-$135.00 $16.00 
$135.01-$170.00$18.00
$170.01-$200.00$20.00
$200.01-$350.00$22.00
$350.01-$500.00$25.00
$500.01-$600.00$28.00
$600.01-$1000.00$33.00

(Return to Main Page)

November 24,2006