Illumination's Order Form
Fax to 336-472-1977

Billing Info

The billing address must match your credit card billing address.

Name_________________________________________________

Email________________________________________________

Phone________________________________________________

Billing______________________________________________

Address______________________________________________

City_________________________ State____ Zip__________

Country______________________________________________

Credit Card #________________________________________

Exp Date____________ Visa, MasterCard, or Discover (circle one)

Shipping Info

To ship candles to an address different than the one above, fill out the shipping address fields:

Name_________________________________________________

Shipping_____________________________________________

Address______________________________________________

City_________________________ State____ Zip__________

Country______________________________________________


How Many Cases:

Tealights (500 in a case) ____________ at $40.00 per case

10 Hour Food Warmer (288 in a case) ____________ at $36.00 per case

15 Hour Food Warmer (144 in a case) ____________ at $30.00 per case

Order by the Case only.
Actual Freight Charge Will Apply

Thank You For Ordering from Illuminations of North Carolina, Inc.