| Name: |
| Address: |
| City: |
| State: |
| Zip Code: |
| email: |
| FREE BLACK-LIGHT: (check one) ___ 18" black-light fixture! OR ___ Multi-purpose mini black-light/flashlight! |
PAYMENT OPTIONS:
| 1. CREDIT CARD: (check one) __ Mastercard __ VISA |
| Card #:________________________________ Exp Date: ___/___ |
| 2. Check or Money Order Payable to Future24. |
Please print and send this form along with payment to
Future24
Lighting Effects Division
21 Terrace Place Suite 1
Fredonia, NY 14063
Thank you for your order! Please allow 2-3 weeks for delivery.
Additional 1 quart smoke fog fluid (optional): $14.95 each plus $5.00
s+h.
