Name   _______________________________________

Address   _____________________________________

                _____________________________________

Telephone   ________________________

Photo ID ___     (attach copy of Driver’s License)

Salesman   _______________________       Sales Inv #  _____________

Instrument   ___________________________      Case:  hard/ soft/ none

Ser #   _______________________________       Credit _____________

Condition __________________________________________________

Serviced by  ________________________

Work done _________________________________________________

___________________________________________________________

Photo ______    On Web ______                                Price at __________

Comments __________________________________________________

___________________________________________________________

___________________________________________________________

I hereby attest that I am the sole owner (or owner’s agent) for the above listed property. Furthermore, I certify that I have the legal right to sell said property and that it is free from all liens and encumbrances.

Signature of Seller ________________________________________ (date)

Signature of Buyer ________________________________________ (date)