SHIPPING REQUEST FORM

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Client Name *

Shipping Address *

Email Address *

Telephone *

Name of Auction *

Check Box

If you want UPS Proof of Delivery with Signature Required for $5.00

if you DO NOT want the item insured for its auction value (items are automatically insured for $100. UPS charges $2.50 per $100 for additional insurance)

Items to be Shipped

Please supply name and item number

Credit Card # *

Expiration MM/YY *

CVV *

Zip Code *

In lieu of picking up the auction items personally, *

I authorize Modern Day Auctions and/or UPS to charge my credit card listed above and/or on file for the $10.00 handling fee, in addition to the packing & shipping charges.

I agree to the terms that Modern Day Auctions LLC is not responsible for any damage, loss or theft when items are transported or shipped. MDA will not issue a credit or refund for the item and/or the shipping costs. All Sales Final. No Returns.

Required

Signature *

Date *

YYYY

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