Customer Order Form
  
   
WARNING! IF YOUR ORDER IS URGENT JUST EMAIL IT TO nneedham@hmlighting.com  
   
Bill To:
       
       
Company Name:
 
 
Address 1:
 
Address 2:
 
 
City:
  
State:
Zip:
 
 
Country:
  
Email*:
        
Phone:
        
Fax:
   
 
Ship To:
    
Company Name:
 
 
Address 1:
 
Address 2:
 
 
City:
  
State:
Zip:
 
 
Country:
  
Phone:
        
Fax:
     
 
Order:
    
       
 
Qty
Part Number
Description
   
   
   
   
   
   
   
   
   
   
   
 
Shipping Method:
  
       
 
Payment Options:
 
     
*PLEASE NOTE H&M WILL NOT CALL FOR YOUR CREDIT CARD INFORMATION. ALL CREDIT CARDS MUST BE CALLED IN BEFORE 2pm PST FOR YOUR ORDER TO SHIP SAME DAY.
       
 
Special Notes:
 
       
      (*) Denotes mandatory field
   
 
     
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   Mail:
   H&M Distributors Inc.
   141 Cassia Way, Suite A
   Henderson, NV 89014
 
   Phone:
   1.702.294.8944
 
   Toll Free:
   1.888.203.6360
 
   Fax:
   1.702.294.8946
 
   Email:
   info@hmlighting.com