ONLINE BIDDER REGISTRATION FORM

ONLINE BIDDER

REGISTRATION FORM
TODAY'S DATE*

MonthDayYear
Date
NEW CUSTOMER (Must complete Buyer Registration form also)EXISTING CUSTOMER (please provide the most recent date you have purchased from Heritage Place)
EXISTING CUSTOMER: Most Recent Purchase at Heritage Place Sale

MonthDayYear
Date
NAME*
ADDRESS*
CITY STATE ZIP*
PHONE*

Area CodePhone Number
EMAIL*
example@example.com
ADVANCE PAYMENT IS REQUIRED FOR ALL ONLINE BIDDING.

PLEASE CHOOSE YOUR METHOD OF PAYMENT BELOW:
METHOD OF PAYMENT:

CREDIT CARD - Please complete information below (a 3.5% office fee is charged on all credit card purchases) The amount you indicate below plus the 3.5% office fee will be preauthorized on your credit card and, if not used, may take up to one week to be releasedWIRE TRANSFER - Please call 405-682-4551 for wiring instructions
Approximate Dollar Amount for Verification*
NAME ON CARD
BILLING ADDRESS
AQHA
CITY, STATE, ZIP
CREDIT CARD NUMBER
EXPIRATION DATE

MonthDayYear
Date
3 OR 4 DIGIT SECURITY CODE
Home Telephone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
By signing this registration, applicant authorizes Heritage Place, Inc. to perform an authorization on the credit card provided. Applicant's signature below also indicates that he/she agrees to the Terms and Conditions in the catalog and that any announcements from the auction block supersede any previous statements, printed or otherwise and that there will be a 3.5% office fee charged on all on-line credit card purchases.
SIGNATURE OF APPLICANT

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Date

MonthDayYear
Date
Please upload copy of your Drivers License

Browse Files
Front and Back copy of drivers license. Cancelof
Should be Empty:

ONLINE BIDDER

ADVANCE PAYMENT IS REQUIRED FOR ALL ONLINE BIDDING.