| First Name: |
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| Last Name: |
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| Company: |
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| Address: |
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| (3rd line) |
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| City: |
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| Zip Postal Code: |
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| Country: |
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| Day Phone: |
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| Evening Phone: |
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| fax number: |
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| email address: |
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Please enter your Shipping details:
(only if different from above) |
| First Name: |
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| Last Name: |
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| Company: |
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| Address Line1: |
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| (2nd line) |
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| (3rd line) |
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| City: |
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| State/Province: |
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| Zip Postal Code: |
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| Country: |
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| Phone: |
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| These items will be shipped via: |
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| How do you wish to pay? |
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| Mail Payment to: |
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Name:
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Lighthouse Crafters |
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Address:
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P.O. Box 43 |
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City / State:
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Wilbraham MA, |
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Zip Code::
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01095 |
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Check / Money order for: :
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$245 |
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Please specify the color scheme and size of your
lighthouse by model number Click here for custom
lighthouse colors & prices
Your lighthouse will be shipped via UPS to you the same
day payment is received.
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