Bast Rd. Online Order Form

Contemporary metal traditionally employed. Warranted by the maker.

Place Your Order With Us Using The On-Line Order Form Below

Mailing Address:

P.O. Box 11

154 The Mill Road

West Rupert, VT 05776

Tel: 802-394-7715 Fax: 802-394-2422

orders@bastroad.com

Date:
Ordered By:
Phone:
Fax:
E-Mail:

Bill To:

Name:
Street Address:
City:
State:
Country:
Postal Code:

Ship To:

Name:
Street Address:
City:
State:
Country:
Postal Code:

First Fixture
Qty.	Model #	# of Arms	Hardware	Finish

Main	Trim	Band	Unit Price	Total

Second Fixture
Qty.	Model #	# of Arms	Hardware	Finish

Main	Trim	Band	Unit Price	Total

Third Fixture
Qty.	Model #	# of Arms	Hardware	Finish

Main	Trim	Band	Unit Price	Total

Lighting Accessories:

Flame-Tip Candelabra Bulbs:

Style of bulb

Qty.

Candle Sleeves:

Style

Qty.

Extra Chain and Wire:

chain & wire

# of feet

Special Instructions:

Please do not send payment until you receive an invoice detailing your order and shipping information with the total cost. Fixtures are usually ready for shipment in 6 weeks and will be sent upon receipt of payment. Payment may be made by personal check or credit card. Please feel free to contact us with any questions.