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Lat i nAmer i c anSal e Wednes dayMay26t hat1pmEDT


□ ABSEN TEE BID □ PHONE BID

SIGN & FAX TO (+1)718.937.0901

SALE TITLE:

SALE DATE: □ CHECK

I F YOU A RE A FI RST TI ME BI DDER

Name (First/Last)

Telephone # (Main)

Company Name (If Applicable)

Telephone # (Alternate)

Address:

Fax #

City, State, Zip Code

Credit Card Number / Type

Circle One: (AMEX, VISA, MC, DISCOVER) □ USE THIS CREDIT CARD FOR MY PURCHASE E-Mail Address:

Credit Card Ex pirat ion Dat e / Sec urit y #

AUCTION BIDDING INFORMATION LOT #

MAXI MU M DOLLAR AMOU NT O R (X) FOR PHONE BI D

LOT DESCRIPTION (TITLE, ARTIST, MEDIUM)

*EXCLUDI NG BUYERS PREMIUM & TAX

$ $ $ $ I Underst and and Agree t o t he Terms & Condit ions of t he Sale and aut horize RoGallery.com Auct ions t o bid on my behalf up t o t he amount st at ed above,

Signature (Req uired )

X________________________________________________________ (Date) Larger Size d A bsent ee Bi d Form Av ailable onli ne at : rogallery .com/absent ee -bidfor m.ht ml



RoGallery.com's Latin American Sale