________________   ___________________  __________

Last Name                    First Name                          MI

 

________________________________________________

Address

________________________________________________            

                 

Zip Code ___________ Phone (_______)______________

Please charge my (circle one)

□ MasterCard    □ Visa   □ Discover □ American Express

Card#____________________________ Exp(mm/yy)____

Security Code____ (last three digits on the back of the card)

 

Cardholder signature___________________ Date_______

If paying by check, please make it payable to: Simpro Inc.

(Please include driver’s license number on the check)

NatureSpiritâ Chandelier/Lighting

1001/12+8+4[  ] _____  x  $1349  =  $_________

1002[   ]               _____  x   $1449 =  $_________

1003[   ]               _____  x   $1149 =  $_________

1005[   ]               _____  x    $299  =  $_________

101[   ] free shipping___  x  $59   =   $_________

TX residents add 8.25% sale’s tax  $_________

Shipping/Hanling/Insurance add $50 each

                                                                 $_________

Total Amount Due                                $_________

 

Please mail your order to:

Simpro Inc. 2018 Primrose Dr, Irving, TX 75063

Order by fax: 1-800-383-2082

www.naturespiritproduct.com

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