Name *

Your name must match the purchaser's name on the auction invoice.

First Name

Last Name

Auction Date *

MM

DD

YYYY

Auction Date

For multiple auction dates only

MM

DD

YYYY

Bidding Platform *

Please enter the platform you used to bid

Liveauctioneers

Invaluable

51 Bid

Telephone/Absentee

Shipping Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Authorized Agency *

You are ONLY allowed to choose one authorized agency; If you chose to use your own shipper PLEASE fill out the next section

Premier Pack N Ship

UPS 5705

UPS 5432

Your own shipper

TERMS AND CONDITIONS: All buyers that won lot(s) in our auction is required to submit a shipping release form in order to release their items to any third party other than the purchaser of record. Wealthier Art & Auctioneers is not liable for any loss or damage during the packing and shipping process of lots won at our auction. *

I certify I am the purchaser of all items stated in this form and agree to all the terms of this form