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For your convenience you can print out this order form by choosing File/Print on your browser. Send it along with your check or money order to:
Peter Summers
501 Plaza Acres Ct.
Belton, MO. 64012

Your Name_________________________________________________________________________

(please print)
Address______________________________________________________________________

City______________________________________________________________________

State______________________________Zip________________


Check the item/items you wish to order

(  )  FLEX ARM GRAND LAMP.....$95.00.

(  )  ADVENT SERIES PIANO LAMP.....$99.95.

(  )  GRAND PIANO LAMP (black) (solid brass).....$250.00.

(  )  BALANCED ARM GRAND LAMP.....$240.95.

Postage paid. Available in U. S. only.

Total Enclosed: $