GREAT NORTHERN ORDER FORM - Type in necessary fields, then print, or print before filling out. To print, set resolution to 1024x768, right click on background, then select "print." Great Northern Livery Company, Inc., N1844 Greenville Drive, Greenville, WI Greenville, WI 54942 Phone: 920/757-5529 Email: livery1@liveryone.net

Carriage Lamps - Candle Powered	Quantity	Total
Anderson Square Lamp - $995/pair
Cart Lamp - $895/pair
Patrician Mail Lamp - $2,095/pair
Options	-----------	-----------
Brass Lamps - add $180
Chrome Lamps - add $240
12v power - add $40
Brackets, primered steel, fit most lamps - $50/pair
Brackets, Patrician Mail Lamp, primered steel - $95/pair
Brass plated brackets - add $60
Chrome plated brackets - add $110
Tax and Shipping	-----------	-----------
WI residents add 5% sales tax	-----------
FedEx shipping to be determined, range $60-$80 inc. ins.	-----------
TOTALS

Name:
Address to ship to (include P.O. box #, apt. #, if any):
City:
State:
Zip:
Country (optional):
Email (optional):
Phone: