AlphaNautical Art Receipt

AlphaNautical Client ID #: _______________ AlphaNautical Art ID #: _______________

TERM: __ Days - From (Date): _______________ - To (Date): _______________

Consignor:
Name of Consignor: __________________________________________________

Name of the Legal Owner of the Art: ____________________________________

Consignor's Address: ______________________________________________________

Consignor's City, State & Zip: ____________________________________________________

Phones: Home: ___________ Office: ___________ Cell: ___________ Fax: ___________

Email Address: ___________________________________________________________

Title of the Art: ________________________________________________________
(Note: If there is not a known title, a title will be assigned by the Gallery Director.)

Name of the Artist: ____________________________________________________

Size of the Art: Height: ___________ x Width: __________

Framed Size of the Art: Height: ___________ x Width: __________

Medium/Material: ___ Oil on Canvas ___ Other - Describe: ____________________

Signed: ___ Yes/No - ___ LL - ___ LR - ___ Other - Describe: ____________________

Dated: _____________

Condition of Art: _______________________________________________________________
Condition of Frame: _____________________________________________________________
Certificate of Authenticity - Y/N From: _______________________________________
Stated value on the Certificate: $______________ Date of Certificate: _________
Agreed Starting Price - Retail: $_______________ Special: $________________
Provenance (Full History of Ownership as known):
_________________________________________________________________________
_________________________________________________________________________

NOTE: Extra large art works may be stored and shown to specific clients
Authorized Prices & Expenses:
Retail: $________ Special (Discounted Price) $_______
Upon the sale of the art, the consignor will receive:
___ (Y/N) A fixed amount of $_________; - Or
___ (Y/N) A fixed percent _____% of the "FINAL SELLING PRICE" less Texas sales tax and any shipping or crating expenses.
NOTE: In the event that the painting is not an authentic original, is not sold, or has to be returned to the Consignor, all shipping, crating and insurance costs will be paid by the CONSIGNOR.

Other NOTES/COMMENTS:
_________________________________________________________________________________
_________________________________________________________________________________

GALLERY OFFICE & SETTLEMENT INFO:

Sold To: ___________________________________________ Date: _____________________

Selling Price of the Art $______________

Less: Repair, Stretching Framing Costs $______________

Less: Commissions (Name:___________________) $______________

Less: Texas Sales Tax $______________

Less: Shipping, Crating & Insurance Expenses $______________

NET PROFIT $______________

NET TO CONSIGNOR/OWNER $______________

Approved:

______________________________
Joseph E. Stephenson - Pres. in ___________ County, Texas on (Date) ____________________.

Selling Price of the Art	$______________
Less: Repair, Stretching Framing Costs	$______________
Less: Commissions (Name:___________________)	$______________
Less: Texas Sales Tax	$______________
Less: Shipping, Crating & Insurance Expenses	$______________
NET PROFIT	$______________
NET TO CONSIGNOR/OWNER	$______________