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Name*
Business Name
Dealer Resale # (Dealers must also sign official state of Louisiana Document)
Address*
City*
State*
Zip*
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Work Phone
Home Phone
Cell Phone*
Fax
Email*
Re-Enter Email*
Auction Date
Invoice #
Credit Card Type VisaMastercardAmerican Express
Credit Card Number
Expiration Date
CVV
I have read and agree to conditions of sale* Read Conditions of Sale
By submitting this form, you agree to pay the amount due according to the cardholder agreement and Crescent City Auction Gallery Conditions of Sale.
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