User Manual

13
Cut Along Dashed Line
Component Order Form
Order Online at www.verilux.com/replacement-bulb
Mail or Fax your order by using this form to: Verilux, Inc., 340 Mad River Park, Waitsfield, VT 05673
Fax: [phone]
Quantity Price Order Code Product
$19.95 CFML27VLX 27-watt Natural Spectrum
®
Bulb
$6.95 Shipping & Handling
Subtotal
Residents of VT, add 6% Sales Tax; of CT, add 6.35%; of MN, add 6.875%; and of CA, add 7.5%
Total Payment Enclosed
Payment Method:
❏VISA ❏MASTERCARD ❏DISCOVER ❏AMERICAN EXPRESS ❏CHECK
Name as it Appears on Card
____________________________________________________________________________________________
Credit Card Number ________________________________________________________________________
Expiration Date _____________________________________________________________________________
Security Code (from back of card) _____________________________________________________________
Authorized Signature (credit card purchasers ONLY)
____________________________________________________________________________________________
Ship-to Address ____________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Phone Number _____________________________________________________________________________
Email Address ______________________________________________________________________________
Thank you for purchasing this Verilux Floor Lamp. For your warranty to be valid, complete
and mail this Warranty Registration in a timely manner. Or, you can register your product
online at www.verilux.com/warranty.
Name ______________________________________________________________________________________
Address ____________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Phone Number _____________________________________________________________________________
Email Address: _____________________________________________________________________________
Model # ____________________________________________________________________________________
Date of Purchase (Month/Day/Year) __________________________________________________________
Warranty Registration
VERILUX INC
PO BOX 451006
OMAHA NE 68145-5006
Please cut out form and send to:
or register online at www.verilux.com/warranty
VF02_MAN_Rev21.indd 13 8/19/15 1:43 PM