MOONBEAM LIGHTS ORDER FORM
www.moonbeamlights.com     Email:moonbeamlights@nc.rr.com
Phone: (919) 518-0658
CUSTOMER INFORMATION
Name:
Company Name: (if applicable)
Street Address:
City                                                           State                          Zip
Phone: (      )
Email Address:
Shipping Address (if different from the above)
	Quantity	Price Per Item	Total Item Price
MoonBeam Base Unit: Comes standard with 4 Panel Mounted Modules and 1/4" Phone Connector. (If ordering multiple units, see reverse side)		$99.99
LED Color Choice  (Circle Your Choice for Each of the 4 Modules)
Module #1 (White, Amber,  Blue,  Green,  Red )
Module #2 (White, Amber,  Blue,  Green,  Red)
Module #3 (White, Amber,  Blue,  Green,  Red)
Module #4 (White, Amber,  Blue,  Green,  Red)
Optional 4" Gooseneck Mounts		$15.00
Which Module(s) should have a Gooseneck Mount? (Circle all that apply)
Module #1      Module #2     Module #3     Module #4
MoonBeam ACCESSORIES
Swivel Mounting Bracket; Velcro included		$19.99
Swivel Mounting Bracket; Suction Cups mounting		$25.99
Cigarette Lighter Power Cable Adapter		$14.99
15 mm Lamp Socket Power Cable Adapter		$19.99
12 Volt 7 Ahr Rechargeable Battery		$19.99
12 Volt Battery Recharger		$29.99
Battery Holder for (8) AA Batteries		$11.95
5 Watt Solar Panel		$79.99
11 Watt Solar Panel		$129.99
READING LAMPS
12 VDC Reading Lamp with Clamp - 8' Cable		40.00
12 VDC Reading Lamp; no clamp		36.00
12 VDC Reading Lamp; no clamp; no gooseneck		30.00
12 VDC Reading Lamp Trio; 3 Clamps		110.00
12 VDC High Power Reading Lamp - 8' Cable		68.00
12 VDC High Power Reading Lamp Trio		149.00
Canopy Light with 12 VDC Battery Pack		52.00
Canopy Light Trio with 12 VDC Battery Pack		126.00
High Power Canopy Light with 2 AA Battery Back		60.00
Please see Reverse Side for Payment Information and Ordering Additional Units	Total this Page
	Total from Reverse Side
	Sales Tax (7% in NC)
	Shipping and Handling
	Total Due
	Quantity	Price Per Item	Total Item Price
2nd MoonBeam Base Unit		$99.99
LED Color Choice  (Circle Your Choice for Each of the 4 Modules)
Module #1 (White, Amber,  Blue,  Green,  Red )
Module #2 (White, Amber,  Blue,  Green,  Red)
Module #3 (White, Amber,  Blue,  Green,  Red)
Module #4 (White, Amber,  Blue,  Green,  Red)
4" Goosneck Mounts		$15.00
Which Module(s) should have a Gooseneck Mount? (Circle all that apply)	Total for 2nd Base Unit
Module #1      Module #2     Module #3     Module #4
	Quantity	Price Per Item	Total Item Price
3rd MoonBeam Base Unit		$99.99
LED Color Choice  (Circle Your Choice for Each of the 4 Modules)
Module #1 (White, Amber,  Blue,  Green,  Red )
Module #2 (White, Amber,  Blue,  Green,  Red)
Module #3 (White, Amber,  Blue,  Green,  Red)
Module #4 (White, Amber,  Blue,  Green,  Red)
4" Goosneck Mounts		$15.00
Which Module(s) should have a Gooseneck Mount? (Circle all that apply)	Total for 3rd Base Unit
Module #1      Module #2     Module #3     Module #4
Special Instructions and Notes:	Page Total                         Add 2nd and 3rd Base Unit Price and carry to front page
Please specify Colors for all Reading Lamps.
PAYMENT INFORMATION
Mail Orders and Payment to:
Visual Systems & Support, Inc.,  5013 Wood Valley Drive, Raleigh, NC  27613
____Cash              ____Check              ____Visa/Mastercard
For Credit Card Sales:
Name (as it appears on card):
City                                                State                                          Zip
Card Number:
Expiration Date:
Customer Signature (Required):
Warranty:   MoonBeam Lights are guaranteed for mechanical defects for 2 years from date of purchase.  Should your system not operate properly within the 2 years, return your unit to Visual Systems & Support and we will repair your unit at no charge. Customer is responsible for shipping cost.  Visual Systems & Support is not responsible for returned units that have been damaged by any type of misuse such as twisted goosenecks, electrical surges or spikes, or damage due to lightning.  All repairs not under warranty will be charged at the then current rate for time and materials.
Return Policy: Since MoonBeam Lights are custom, made-to-order, all sales are final.