PURCHASE/HOLD REQUEST

Please complete the following to make purchases, place items on hold or request condition reports.

Stock ID	Description	Price
	I wish to purchase the listed items
	Hold my selections for 3 days
	Send condition reports
Client	Information
Name
Company
Address
City/Town
State	Alabama----------------------------------------------------- Alaska Arizona Arkansas California Colorado Connecticut Delaware Disctrict of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zipcode
Tel
Fax
E-mail
	Delivery address is same as above
Ship to
Name
Company
Address
City
State/Town
Zipcode
Tel
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Comments or Questions
	By submitting this form I accept the Conditions of Sale. We will send an invoice or answer your inquiries by e-mail as soon as possible.