LEDress Order Form ( If ordering more than one unit, write plainly on this form what you want, or print more copies of the form. Total the prices. ) Your LEDress display numbers: __ __ __ __ __ Enclosure style: ( circle one ) HORIZONTAL ( display numbers are side-by-side ) VERTICAL ( display numbers read top-to-bottom ) Color of Enclosure: ( circle one ) WHITE GRAY BLACK Color of LEDs: (circle one) RED GREEN ORANGE YELLOW BLUE WHITE Price of LEDress unit: $ ________ (See "pricing" webpage) OPTIONAL Kits: Mounting Kit (enter $4) $ ________ (See "mounting" webpage) Wiring Kit ( 20 cents/foot x ___ feet) = $ ________ (See "wiring" webpage) Total dollar amount of this order: $ ________ If using wiring kit, wire staples color: ( circle one ) WHITE BROWN Ship-to Name: ____________________________________ P.O. Box or Street Address: ____________________________________ City, State, Zip ____________________________________ E-mail Address: ____________________________________ (email is optional: for sending order confirmation and shipping dates to you) Today's date: ____________________________________ Make payment out to: The Logician, LLC Send this form and payment to: The Logician, LLC 4833 SE 47th Avenue Portland, Oregon 97206 Thank you--this order will be given prompt attention.