ARTWORK REGISTRATION FORM FOR DEALERS

Collector Information
Please enter the collector's name and ENTIRE MAILING ADDRESS. This will insure that the mailing address is correct and that the name is spelled correctly on the Certificate of Authenticity.

Collector's Name:
Address:
City:
State:
Zip:
Social Security #:
Phone:
Dealer Number:

Artwork Information
You may enter the first few letters of the name of the Artwork in the blank and press Search to quickly find the Artwork you wish to register. Scroll down to find the exact item.

Name Of Artwork:
Edition Number:   (if applicable)
Purchase Date:  Month        Day         Year

Price:  Dollars     Cents
. (Do NOT enter the decimal)

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