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On-Line Quote Form
To request a quote, please fill in the information below.
The ** indicates information that must be provided to properly process your order.
If you have any questions, please do not
hesitate to inquire through
email
or call us direct at the above number.
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#1: Contact Information
Date:
Company Name:
**
Contact Name:
Title:
Contact Fax:
**
Billing Street Address:
City:
State or Prov.:
Zip/Postal Code:
.
Telephone #:
Ext.
Fax #:
Email Address:
**
Project Name:
**
Ship to Zip Code:
**
PO Due Date:
#2:
Product Lines
Nightingale Brass 'n Color Table & Floor
*Models that include night light and receptacle. **Alzheimers style with
night light, guard difuser, perma-mount and rocker switch.
Model:
Select
343
345*
346**
347
348
349
743
745*
Shade:
Select
DuraLast
PolyLast
PolyLast II
Coolie
Drum
Finish:
Select
White
Almond
Ebony
Mauve
Taupe
English Bronze
Forest Green
Wedgewood Blue
Burgundy
Midnight Blue
Options:
Custom Finish
Perma-Mount
Energy-Saving
Guard
Night Light
Hospital Grade Wiring
Electrical Outlet
Quantity:
Nightingale Brass 'n Color SpaceSaver 535
Model:
Select
535*
Shade:
Select
DuraLast
PolyLast
PolyLast II
Drum
Coolie
Finish:
Select
White
Almond
Ebony
Mauve
Taupe
English Bronze
Forest Green
Wedgewood Blue
Burgundy
Midnight Blue
Options:
Custom Finish
Energy-Saving
Guard
Night Light
Electrical Outlet
Hospital Grade Wiring
Quantity:
Nightingale WallMount SwingArm
Model:
Select
637
638
639
Shade:
Select
PolyLast
PolyLast II
Finish:
Select
White
Almond
Ebony
Mauve
Taupe
English Bronze
Forest Green
Wedgewood Blue
Burgundy
Midnight Blue
Options:
Custom Finish
Energy-Saving
Guard
Pull Chain Switch
Electrical Outlet
Night Light
Quantity:
PolyLast Shade & Brass Accents standard with Model 637.
Smaller PolyLast II Shade standard on Models 638 & 639.
Nightingale PolyLamp 350
Model:
Select
350
Shade:
Select
PolyLast
Finish:
Select
Almond
Putty (light gray)
Mauve
Forest Green
Wedgewood Blue
Burgundy
Options:
Energy-Saving
Guard
Hospital Grade Wiring
Quantity:
Nightingale Heavy-Duty Table & Floor
Model:
Select
326
335
335-CP chrome
453
453-CP chrome
Shade:
Select
DuraLast
PolyLast
PolyLast II
Coolie
Finish:
Select
White
Almond
Ebony
Mauve
Taupe
English Bronze
Forest Green
Wedgewood Blue
Burgundy
Options:
Custom Finish
Hospital Grade Wiring
Perma-Mount
Table Tray (Model 453 Only)
Energy Saving Package II
Quantity:
Nightingale Studylamp 336
( Available only with the PolyLast II Shade)
Model:
Select
336
Options:
Energy-Saving
Quantity:
Nightingale Lamp Shades
Institutional- Grade:
Enter Quantity to order in appropriate quantity and price box
Part #
Description
Qty 1-5
Qty 6-11
Qty 12-18
Qty 19-24
Qty 25+
#14063
DuraLast Shade, 6.5"x14"x 6.5"
#13794
PolyLast II Shade, 5"x11"x 9.75"
#11750
PolyLast Shade, 7"x15"x 10"
Commercial - Grade:
Enter Quantity to order in appropriate quantity and price box
Part #
Description
Qty 1-5
Qty 6-11
Qty 12-18
Qty 19-24
Qty 25+
#10128
Trilam Coolie-Shaped Shade, 5"x19"x8"
#10077
Trilam Coolie-Shaped Shade, 6"x16"x7"
#10174
Trilam Drum-Shaped Trilam Shade, 13"x15"x12"
Comments:
© Copyright 2007 by Adjustable Fixture Co., and
Web Centers of America, Inc.
