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______________________________________________

Economy Luminaria Kit (Tealight and bag) ____________ at $0.25 each

Regular Luminaria Kit (Regular Votive, cup and bag) ____________ at $0.40 each

Long Burning Luminaria Kit (Long Burning Votive, cup and bag) ____________ at $0.45 each

Weather resistant "Double Wax" Paper Bags ____________

White Plastic Luminary Buckets ____________

Clear Plastic Luminary Buckets ____________

Minimum order of 100 Kits.
Actual Freight Charge Will Apply

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