Adjustable Fixture Co - Multi-Housing Sample Request

Nightingale No-Risk 30-Day Sample Offer

To request a Sample(s), 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.
Remember do NOT use the ENTER KEY on this page. (Tab Key or Mouse only)

NO-RISK SAMPLE:
Try a lamp for 30 days and compare it to any other lamp you may be considering. You will quickly discover the Nightingale advantages: special features, heavy-duty construction and low life-cycle costs. Please fill out the following form or call us at the above number and we will rush you a sample within a week. The lamp may be returned at any time during that period at no cost to you. After 30 days, return it or send us your payment (50% off list price). It's that easy to try the best from Nightingale.

#1: Contact Information
Date:
Contact Name:		Contact Phone:
Contact Fax:		Contact Email:
BILL TO :
Company/Name:	**	Address:	**
City:	**	State/Prov.:	**
Zip/Postal:
SHIP TO: (if different)
Company/Name:		Address:
City:		State/Prov.:
Zip/Postal:
#2: Model Sample Type YES, Please rush me a sample Nightingale® Lamp for my use - for free - for a month. I understand I am under no obligation and the lamp can be returned at any time during that period at no cost to me. If I keep the lamp, the delivered price is payable at the end of the 30 day trial period - Prepaid shipments in the continental US Only.

Model:	Shade:	Color:
Option #1: Option #2:

Comments: