Healing Lamp Order Form

Order Form

To Print: click the PRINT button at the top of your screen (sometimes click FILE first)

Your Information:

Name: _____________________________

Telephone: _________________________

Address: ___________________________

City _________________ Zip _________

Email: _____________________________

Shipping Information (if different):

Name: _____________________________

Telephone: _________________________

Address: ___________________________

City _________________ Zip _________

Email: _____________________________


Item Description	Price	Quantity	Total





		add Shipping For FIT lamps $29.95: AK $79, HI $99
			Total

Please make check or money order payable to Healing Lamp

Mail to:
Healing Lamp
2570 S.E. Creighton Ave.
Milwaukie, OR 97267