James Submission Spence Authentication, Form LLC

www.SpenceLOA.com

For Office Use Only

DIR

Submission #

Source:

Date / Time:

CC Approval

Name and/or Company

Ship to Street Address (NO PO BOX)

City, State, Zip

Email:

Business Phone: (circle one) Dealer Auctioneer Collector Non-Collector Cell Phone: Ask us about scheduling a House Call or Store Visit. All fees must be paid in advance before we can process your order. Incomplete or illegible submission forms will delay turnaround time. We reserve the right to correct your submission form to reflect our current authentication fees. All fees are applicable regardless of outcome of authentication. Qty ITEM TYPE AUTOGRAPH THEME AUTHENTICATION FEE

(Check One Service)

FOR OFFICE

USE ONLY

DECLARED

VALUE

Who Signed Your Item? Amount Basic Cert LOA Certification # Thank You, TOTAL AUTHENTICATION FEE(s)/VALUE $ $

**MUST CHECK ONLY ONE**

Do you want a certification label on your item(s)? OR on your (LOA)

Letter(s)?

The pressure sensitive alpha numeric sticker cannot be removed without voiding. JSA will assume discretion if the choice is not made by the submitter. I have read and agree to the JSA authentication terms and conditions on the back of this form.

AUTHORIZED SIGNATURE

(mandatory) DATE

UPS Return Shipping Method see rate chart on reverse All Shipments with a total declared value of $1000 or more will be returned Signature Required

Ƒ ND Air Saver Ƒ 2nd Day Air Ƒ 3 Day Ƒ Ground

OR use your UPS Acct enter here #

For FedEx, you MUST USE YOUR ACCT #

Ƒ Priority Ƒ Standard Ƒ 2nd Day Ƒ Exp Saver

$

$

1.Total Authentication fee(s)

2. Shipping / Handling / Insurance (see reverse)

3.Total Charges (sum 1 & 2) $

Method of Payment

PIE - Basics

Check or Money Order Cash $

# 5HF G E\

Ƒ Visa Ƒ MC Ƒ Discover

Card #

Exp Date CVC Code

Cardholder Name (sign here)

Merchandise Pick-Up Authorized Signature Date: 2 Sylvan Way Suite 102

Parsippany, NJ 07054-3809

888-4-JSPENCE 973-***-****

Fax: 973-***-****

ad5b31@r.postjobfree.com

3223 N.W.10th Terrace, Suite 605

Fort Lauderdale, FL 33309

954-***-****

Fax: 954-***-****

ad5b31@r.postjobfree.com

Terms & Conditions

U.S. RETURN POSTAGE AND HANDLING FEES- UPS DOMESTIC SHIPPING ONLY Estimated Value Next Day Air Saver 2nd Day Air 3 Day Select Ground

$0-$499 $79.00 $41.00 $32.00 $22.00

$500-$999 $83.00 $45.00 $35.00 $26.00

$1,000-$1,999 $90.00 $52.00 $43.00 $35.00

$2,000-$2,999 $98.00 $60.00 $50.00 $43.00

$3,000-$4,999 $113.00 $75.00 $65.00 $58.00

$5,000-$6,999 $128.00 $90.00 $80.00 $73.00

$7,000-$9,999 $150.00 $112.00 $104.00 $99.00

$10,000-$14,999 $188.00 $150.00 $140.00 $136.00

$15,000-$19,999 $225.00 $187.00 $178.00 $168.00

$20,000-$24,999 $263.00 $225.00 $215.00 $219.00

$25,000+ CALL CALL CALL CALL

JSA Customer Service Toll Free Line 888-4-JSPENCE 888-***-****) www.SpenceLOA.com ad5b31@r.postjobfree.com ad5b31@r.postjobfree.com For shipments to Canada and Overseas We will use the U.S. Postal Global Express Service for return shipping. Go to https://postcalc.usps.com/ or call our office for pricing.

* Residential addresses must apply an additional $4.00 to above charges.

* Various zip codes may incur additional charges.

1. For purposes of this Submission Form, James Spence Authentication, LLC, its employees, agents, representatives and/or affiliates are referred to as “JSA”.

2. JSA will endeavor to certify submissions within a reasonable time frame. Certification and authentication may involve a collective judgement that is subjective and may require the collaboration of professional opinions which may change from time to time. Therefore, JSA makes no warranty or representation and shall have no liability whatsoever for the time frame to certify a submission nor the opinion rendered. 3. JSA will not be responsible for, nor have an opinion of authenticity, on any item not listed on the submission form and/or accompanied by a JSA result document.

4. All fees paid to JSA are NON-REFUNDABLE. Any payments made via check which are declared NSF, or uncredited checks issued by customer to JSA will incur additional assessed bank fees and charges. 5. JSA exercises reasonable care in handling item(s) submitted for authentication. If JSA determines the customer’s item(s) was lost or damaged while in JSA’s possession, the customer will be credited in the form of a CREDIT VOUCHER in an amount determined by JSA in its sole discretion which may differ from the customer assigned declared value of the item(s). Any credit issued by JSA will be in the form of a CREDIT VOUCHER that is non- transferrable and valid for (1) year from the date issued. JSA shall have no liability whatsoever for any loss or damage of any submitted item(s) that is not in the custody or control of JSA, including but not limited to UPS or FedEx. 6. Customer agrees to immediately inspect all submitted items, submissions and LOA’s (Letter of Authenticity) and report to JSA any damages, discrepancies or mechanical errors within two (2) business days of receipt. Upon customer’s notification JSA will provide instructions and necessary steps to resolve. Mechanical errors include, but are not limited to, such errors as incorrect date, designation, name of signer(s) and description of submission. Customer agrees to indemnify and hold harmless JSA and its affiliates against all losses and/or claims (including attorney’s fees and court costs) caused by the circulation or sale of a mismarked or inappropriate item or any unauthorized use of a JSA certificate or label. 7. Except as expressly set forth herein, JSA disclaims any and all warranties, express or implied, (including the warranty of merchantability and the warranty of fitness for a particular purpose) regarding its services. 8. The courts of Morris County, NJ shall have exclusive jurisdiction and venue of any controversy or claim arising out of or relating to any submissions to JSA and THE PARTIES IRREVOCABLY WAIVE THEIR RIGHTS TO A TRIAL BY JURY WITH RESPECT TO ANY SUCH CONTROVERSY OR CLAIM. The court shall award to the prevailing party, in addition to any other relief deemed appropriate, the prevailing party’s attorney’s fees and costs of litigation, whether or not those are otherwise available to the prevailing party by statute. 9. All submission results will be sent by mail. It is against JSA policy to provide results by phone, fax, or email. No exceptions will be made. 10. Any submissions/items held by JSA for a period of 90 days from the date of the submission that has not been paid for will be placed in JSA storage and may incur additional charges.

1. Confirm that your autograph(s) are listed on the fee schedule. If not, email or call our office for a quote ad5b31@r.postjobfree.com, 954-***-**** or 973-***-****.

2. Enter the quantity, item type, autograph theme and authentication fee. Items valued over $200.00 require an LOA. 3. Enter a declared value, this is for insurance purposes only. We don’t advise on valuation. 4. Select a return carrier, UPS or FedEx, according to the instructions on the front of this form. 5. Select placement for your tamper evident label. Please pick only ONE. 6. Enter payment information CLEARLY & LEGIBLY. Failure to do so will delay processing of your submission. 7. Pack your item securely and include your submission form and remember to keep a copy for yourself. We will not proceed with our service until a signed submission form is received.

8. Send your item(s) to: James Spence Authentication, LLC (Florida Office) 3223 N.W. 10th Terrace, Suite 605, Ft. Lauderdale, FL 33309

–OR–

James Spence Authentication, LLC (New Jersey Office) 2 Sylvan Way, Suite 102, Parsippany, New Jersey 07054 James Spence Authentication, LLC Submission Form Instructions

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