If you do NOT receive a confirmation within 48 business hours after submitting your order, simply fill out the form below. Please do NOT telephone our Main Line as this form goes to a complete different location. ENTER CONTACT INFORMATION Company Name: (if applicable) Name: Address: City: State: - Select Your State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside US Zip: Phone Number:  Important to provide a good Phone number as your order will NOT be processed until after we contact you for confirmation, faxed signature and payment information. Fax: Important to provide a good Fax number as your order will NOT be processed until after we contact you for confirmation, faxed signature and payment information. Alternate / Cell Phone: The sooner we can contact you, the sooner you will receive your order. Therefore we ask for an alternate phone number, preferrably a cell phone. Email: Date of Order Placed: Product You Ordered: Comments: IMPORTANT: Phone and Fax MUST be accurate. Fax Number is Required as we will be faxing you an Authorization Sheet and need you to fax it back with your signature. Production of your Create-A-Lite order will NOT begin until we have your Signed Authorization faxed back to us.

We have a $100 minimum order requirement before any other charges. Thank you.

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