If you are the purchaser of an auctioned item and someone other than yourself will be picking up the
item, you must print, complete, and send this form along with a printed copy of your paid receipt with your authorized agent.

A person that has been disabled from the eBid system for any reason will not be allowed to claim items for another buyer.  A person that has been disabled from the eBid system cannot be named as the buyer’s agent below.

Buyers Full Name:  __________________________________

Are you a Metro Employee?  £ Yes  £ No

Auction Item ID#:  ______________________________________________________________

_______________________________________________________________________________

Agent's Full Name: _____________________________________

I, the buyer shown on this form, authorize as my agent as shown on this form, to receive said item
and relieve the Metropolitan Government of any liability regarding the release or damage of this property.

BUYER

By signing below, you are agreeing that the item has been visually inspected and that you are accepting
the item in its current condition. You also understand that there will be no refunds or returns.

State of Issuance: ____     DL Verified:  £  DL On File:  £

Buyers Signature: ______________________________________    Date: _________________

AGENT

State of Issuance: ____     DL Verified:  £

Agents Signature: ______________________________________    Date: _________________

Rev: October 20, 2009