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*
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
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone 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

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

ONLINE BIDDER

ADVANCE PAYMENT IS REQUIRED FOR ALL ONLINE BIDDING.