Adjustable Fixture Co

On-Line Form

To request a Sample(s), please fill in the information below.
IIf you have any questions, please do not hesitate to inquire through email
or call us direct at the above number.
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Task Lighting Products

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. It's that easy to try the best from Nightingale® and Ajusco®.

#1: Contact Information
P.O. #		Date:
Account #:
Contact Name:		Contact Phone:
BILL TO :
Company/Name:	**	Address:	**
City:	**	State/Prov.:	**
Zip/Postal:		Country:
Phone:	**	Email:	**
SHIP TO: (if different)
Company/Name:		Address:
City:		State/Prov.:
Zip/Postal:		Country:
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#2: Product Lines

Task Lamps
Model: Shade:
	Base Price Total Cost:
#3: Charge Card Information
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