Thos. Cornell Galleries, Ltd

76 WEST MAIN ST. PATCHOGUE, NY 11772

631-289-9505  631-289-9507 fax

BIDDER REGISTRATION

BIDDER #_________                                                                                                  SALE DATE__________

DRIVER'S LICENSE # (INC. STATE) _______________________________________________________________________

CREDIT CARD # & EXP. DATE _________________________________________________________

*****CREDIT CARD CODE #____________  

ATTENTION DEALERS

BILLING NAME & ADDRESS MUST AGREE WITH YOUR STATE OR LOCAL SALES TAX EXEMPTION CERTIFICATE, INVOICES CANNOT BE CHANGED ONCE THEY HAVE BEEN PRODUCED

COMPANY NAME OR FIRST NAME LAST NAME

BILLING NAME  ___________________________________________________________________________________________

Address____________________________________________________________________________________________________

City & State, Zip Code  ___________________________________________________________________________

Country  ______________________________________________    Telephone# _____________________________

ITEM #

DESCRIPTION OF ITEM

AMT. BID

Bidders are reminded that the purchase price payable by the successful bidder shall be the total of the final bid and a premium of 18%, together with any New York state local sales tax or compensating use tax of another state which may be applicable.

I AGREE THAT I WILL BID SUBJECT TO THE TERMS & CONDITIONS OF SALE.

My signature below authorizes THOS. CORNELL GALLERIES, LTD. to charge my credit card for the sum total of my purchases including the Buyer’s Premium & sales tax  within 3 days of the auction in the event that I have not paid for my purchases

ALL SALES ARE FINAL

Signature________________________________________________ Date_________________________