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Order Online
Company*
Full Name*
First Name Last Name
Phone Number*
- Area Code Phone Number
Purchase Order*
Delivery or Will Call*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Devices
Device Type*
Are Receptices Decora?
Device Color*
Tamper Resistant?*
Single Pole Switch
Box of 10
Three Way Switch
Box of 10
Four Way Switch
Box of 10
15 Amp GFI Recepticles
Duplex Recepticles
Box of 10
Single Recepticles
Range Recepticle
Dryer Recepticle
Do You Need Dimmers?
Single Pole 600W
Three Way 600W
Single Pole 1000W
3 Way 1000W
Other:

Cover Plates
P1 Single Switch Plate
Box qty 25
P2 Two Gang Switch Plate
Box qty 20
P3 Three Gang Switch Plate
Box Qty 15
P4 Four Gang Switch Plate
Box qty 10
P8 Recepticle Plate
Box qty of 25
P18 Switch/Duplex Recepticle Plate
P88 (P82) Two Gang Duplex Plate
P7 Single Recepticle Cover
1 Gang Blank Plate
Box qty of 20
2 Gang Blank Plate
Box qty of 20
Two Gang Range/Dryer Plate
Box qty 20
Phone Plate
Box qty 10
TV Wall Plate
Box qty 10
Phone/TV Combo Plate
Box qty 10
Other:

Can Trims
6" White Baffle
Box qty 8
Air Tight (Cone)?
6" White Eyeball
6" Regressed Eyeball
6" Shower Trim
5" White Baffle
5" White Eyeball
5" Shower Trim
4" White Baffle
4" White Eyeball
Other:

Lamps
65 Watt BR 30
Case Qty 24
50 Watt R 20
60 Watt A19 Lamp
40 Watt A19 Lamp
75 Watt Par 30
50 Watt Par 30
50 Watt Par 20
75 Watt Par 30 Long Neck
50 Watt Par 30 Long Neck
Other:

Breakers
1 Pole 20 Amp Breaker
Box qty 12
1 Pole 15 Amp Breaker
Box qty 12
20 Amp Twin Breaker
Box qty 12
15 Amp Twin Breaker
Box qty 12
2 Pole 30 Amp Breaker
Box qty 6
2 Pole 40 Amp Breaker
Box qty 6
1 Pole 15 Amp Arc Fault
Box qty 10
Other:

Misc. Items
1 Gang Cut in
2 Gang Cut in
3/0 Cut in
Pull Out AC Disconnect
Smoke Detector Brand
Smoke Detector
Smoke / CO Combo
Chime Kit
Weather Proof Duplex Cover (Flip Lid)
1G Weather Proof Blank
Bubble Cover
3' Disposal Pig Tail
LED Stair Light
Keyless Lamp Holder
Pull Chain Lamp Holder
Fart Fan Finish (1688F)
Exhaust Fan Flapper Color
Exhaust Vent Flapper
Exhaust Fan Under Eve Vent
Are you Human?*
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