Gates-Moore Lighting

Order Form

Contact Information
Name * First Last
Contact Email *
Contact Phone * - (###) - ### ####
Please enter your phone number, so we may contact you about the order and get the billing information for processing. Thank you.
Fax number - (###) - ### ####
When would be the best time to contact you? Morning 8-12AM Afternoon 12-5PM Evening 5-10PM Anytime
Product(s) Information - Select up to 5 items you want to purchase per order
Item 1 - Catalog Number *
Finish *
Item 2 - Catalog Number
Finish
Item 3 - Catalog Number *
Finish
Item 4 - Catalog Number
Finish
Item 5 - Catalog Number
Finish
Ceiling Height
Length from ceiling to lowest part of fixture
Type
Additional options Staining Crating
Additional notes for processing
Billing Information
Payment method * Call me for billing information Use the billing information below
Credit Card Number
Expiration Date (Month/Year)
Name of the Card Holder First Last
Billing Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Shipping Information
My shipping address is the same as the billing address (no need to enter it twice)
Shipping Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Type the letters you see in the image below.