PRINT OUT THIS ORDER FORM AND FAX IT TO (718) 292-6461

RAPIDLITE FIXTURE CORPORATION.

MANUFACTURERS AND DISTRIBUTORS OF

FLUORESCENT AND INCANDESCENT LIGHTING

Residential and Commercial Showroom

280 East 149^th Street, Bronx NY 10451

www.rapidlite.com

rapidlite@aol.com

CALL (718) 292-6460

FAX (718) 292-6461

PURCHASE ORDER FORM

DATE: ______ / _____ / 20____ ORDER #: ______________________

FROM: ____________________________________ VENDOR: ________________________________

ADDRESS: _____________________________________________________________________________

CITY: ___________________________ STATE: _________ ATTN:_______________________________

QUANTITY

CATALOG #

UNIT COST

EXTENTION

COMMENTS

ORDER MEETS FREE FREIGHT REQUIREMENTS ? “ YES “ NO

BACK ORDERS ACCEPTED “ YES “ NO

24 HOUR ADVANCED NOTIFICATION REQUIRED “ YES “ NO

BACK ORDERS AUTOMATICALLY CANCEL _____ DAYS AFTER ORDER DATE

ANY DAMAGES INCURRED DURING SHIPPING WILL NOT BE ACCEPTED ALL DELIVERIES ARE TO BE SENT TO 280 E. 149^th St., BRONX, NY UNLESS INDICATED OTHERWISE DELIVERY HOURS ARE FROM 9 AM TO 4 PM MONDAY TO FRIDAY

PLEASE CALL FOR ANY ORDER CLARIFICATIONS OR COMMENTS

AUTHORIZED BY: _________________________