If you would prefer to use a cashiers check or money order and bypass using the web 
ordering all together, You can simply send us this order form with a cashiers check
or money order for the total amount and we will gladly handle the order for you. You
can also Fax this form to us at 1 (270)721-0073. No personal checks please!

CASHIERS CHECK OR MONEY ORDER/FAX FORM                     BLACK LIGHT WORLD
1.Fill out and print the following form. We do not ship to Outside the USA.
WE DO NOT ACCEPT PURCHASE ORDERS. ALL ORDERS SHIP GROUND SERVICE ONLY!
  
First Name: Last Name:
Company name:

Ship to Address:
Street: City: State:

Zip Code:

 Phone # Fax#

e-mail:  Fill out to receive your Tracking Number.

Billing address (Leave Blank if same as above)
Street: City: State:

Zip Code: Credit Card (Circle One):

Credit card # (If Applicable) Expiration date
Security Code Reverse side. Include all digits  American Express Security digits are on the front side of card 

By entering this information you authorize Blacklightworld to charge your credit card. We accept Visa, Mastercard, American Express, and Discover.

Selected item (s) :
  Qty           Item Name                                              Item #

Special Instructions or comments:

Subtotal amount:

Shipping:       Below rates are within the USA only!
The following rates apply to check, money orders, or faxed orders only for USA ONLY! 
$0.01-$10.00 dollars $6.95
$10.01-$50.00: $8.95
$50.01-$100.00: $9.95
$100.01-$200.00: $12.95
$200.01- Up: $14.95
ABOVE RATES ARE NOT FOR DISTRIBUTORS OR  DISCOUNTED PRICING. WEB PURCHASES ONLY.

Kentucky residents add 6.0% sales  tax

Grand Total:  

Signature:

2.Send form (be sure to include Cashiers Check or Money Order if applicable) to:

BLACK LIGHT WORLD 
PO Box 26
Cub Run, Ky 42729

Or Fax to BLACKLIGHT WORLD

1(270)721-0073