Information Request Form Privacy Rights We respect and are committed to protecting your privacy. The information we collect from you is used only by antique lights and is not given out to any other source. Payment Terms Visa/MasterCard , Personal Check (10 days to clear), are all accepted. Customer will assume shipping and handling fees. Although we pack our lights with great care and have an excellent shipping record all our lights are insured. When purchasing an Antique Light from us please tell us the item number of the light you want to buy. You can call us with your credit card number or we can call you (please let us know best time to call ). Don't worry about the length. Our fixtures can be shortened or lengthened. We would appreciate you filling out the following particulars so that antique lights can provide the best customer support possible. This form is for serious inquires only.

* = (required) Your Full Name: * Your Email Address: * Your Phone Number: What are the Light item numbers of the lights you are interested in? i.e 678OS. * If you have any other comments or questions please enter them here. ___ information to Genuine Antique Lighting.