Clock Listing Form

The Clock Guy Antique Brokerage – Listing Form

Please fill in and e-mail this Word file back to: TODAY’s DATE:

Where there are multiple selections, please delete all but the applicable answer. If a question does not apply, mark “N/A”

ITEM DESCRIPTION: /
Circa:
Manufacturer:
Time Shown on Dial in Photo:
Country of origin: / [US] [Germany] [Austria] [UK] [France] Other:
PHYSICAL SIZE: / in. wide in. high x in. deep
Clock physical weight (estimate for larger items): / lbs.
MOVEMENT TYPE: / [time] [strike] [fusee: 1 2 3 ]
Movement technical description (if known): / [deadbeat] [retain pwr] [platform] [countwheel] [balance wheel]
Duration days (how long does it run on a winding?): / [8-day] [30-day] [60-day] [1 yr] [30-hr] Other:
MOVEMENT POWERED BY: / [Spring(s) # ] [Weight(s) # ]
MOVEMENT MECH CONDITION(be specific):
Movement original to case?: / [y] [n]
Movement signature: / [none] signed where?: Signature says:
Movement serial #. / [none] serial #
REPAIRS (details and dates): / [serviced when: ] [overhauled when: ]
Strikes on: / [rod-(# )] [gong-(# )] [bells-(# )] [tubes-(# )]
Chiming pattern: / [Westminster] [Whittington] [St Michaels] [AveMaria] other:
Chimes on: / [qtr] [half] [hour] [gr-sonnerie] [petite sonnerie] [music-box] [organ] other:
Calendar present: / [y] [n] Original to case? [y] [n]
Calendar mechanical condition:
Calendar roller papers original?:
Calendar comments:
DIAL DIAMETER: / in. [“Cartouche” porcelain numerals? (y) (n)]
Dial Signature:
Dial material: / [painted] [porcelain] [paper] [silvered] [brass] [engraved] other:
Dial original to clock? / [y] [n] [Refinished? (y) (n) ] [open escapement? (y) (n)]
DIAL CONDITION: / [excellent] [very good] [good] [poor needs-refinish]
Dial damage (if any): / [none] Badly Worn: [paint/paper] [chipped] [cracked] [hairlines]
CASE DESCRIPTION (wood type, style, etc.) : / [Oak] [Walnut] [Mahogany] [Alder] [Rosewood] [Flame] [Cherry] Other:
Case condition: / [excellent] [very good] [good] [poor] [crazing] [Rubbed/Polished?]:

Case Serial Number:

CASE REFINISHED? / [y] [n] Refinished when: [n/a] older recent
Refinish material: / [n/a] [lacquer] [varnish]
Other case comments:
Label/Markings (location? original to this clock?): / [n/a]
Label(s) condition: / [n/a] [excellent] [very good] [good] other:
GLASS: / [all original] [REPLACED: upper, lower, lft side, rt side] [bubbly? (y) (n)]
OTHER COMMMENTS(history of item, etc.)
(we determine this together) Asking Price: / $/
Your Name:
Address:
City, State, Zip/Postal Code
Daytime Phone:
Evening Phone:
Cellular Phone:
E-Mail Address:

The statements made above are accurate. We hereby certify that we are the legal owner of this clock and have full legal right to sell it. We understand that, in listing this clock for sale, we are asking The Clock Guy Antique Brokerage (TCG) to invest considerable time and expertise in marketing the clock. Therefore, we commit to keep/honor this listing for a period of not less than 90 days, renewable automatically for 180 days and thereafter, unless we notify TCG in writing 10 days in advance of 90 days from the date herein. All flaws or replacement components of any nature, whether in the case, glass, dial, movement, etc., have been disclosed to TCG to the best of our knowledge. We accept full responsibility for any/all misrepresentations in this information. We understand that all clocks shipped by/for TCG will be commercially packed and fully insured with packing, insurance and shipping costs paid directly to the packer/shipper by the buyer at their expense. We agree to assist TCG to locate a local packer if requested, and will deliver, or arrange delivery of, the item to the packer unless otherwise agreed by TCG. We agree to immediately notify TCG if any additional information about the item becomes available to us, or if its ownership status changes. At our expense, we agree to supply TCGwith high-quality digital photos. (Note: if this file is e-mailed to us we will consider your signature applied as of the date of the e-mail message if you do not have a digital signature you can paste in here, but please insert today’s date top and bottom of this form.) If there are any direct expenses to The Clock Guy to prepare this clock for sale (such as repairs or outside photo-editing), they will be deducted, at cost, from the proceeds at the time of sale.
(required) Signature:Date:

This form is copyrighted 1998-2008 by The Clock Guy Antique Brokerage ( and may not be used or duplicated in any form whatsoever