Name _________________________________________ Email: ________________________________________________

Home Phone: _______________________________Alternate Phone: ________________________Fax#_________________________

Address ________________________________________________City ___________________________ State                    Zip ________

TAX EXEMPT BUYERS MUST PRESENT A COPY OF RESALE CERTIFICATE – PLEASE CONTACT GALLERY FOR FORM.

Signature:  ____________________________________________________________________ DATE __________________________

                   Bids will not be executed without signature.  Signature denotes that you agree to our terms.

**IN ORDER TO HOLD YOUR BIDS, A CREDIT CARD (VISA, M/C, OR DISCOVER) IS REQUIRED**
Any uncollected payments will automatically charge to this credit card 5 business days after purchase

Credit Card #_________________________________________________________ Expiration Date____________ Security Code_______

Cardholder's Signature:  _________________________________ Billing Address:________________________________________________

LIVE AUCTIONEERS BIDS are subject to a 21% BUYER’S PREMIUM!