Petroleum Collectible Appraisal Form Oil Company Collectibles, Inc. P.O. Box 556, LaGrange, OH 44050 U.S.A. Phone: 440/355-6608 Name: ________________________________________ Address: _____________________________________ City: ________________________________________ State or Province: ___________________________ Zip or Postal Code: __________________________ Phone Number: ________________________________ E-mail Address: ______________________________ Description of item(s) to be Appraised: Please include all writing on globes or signs. For signs, please indicate size and whether porcelain or tin. For globes, please indicate if it is two sided and whether it is on a glass, metal or plastic frame. Condition: Please indicate any wear, discoloration, chips, fading, if not in mint condition. Photo: may be necessary to complete appraisal. Please include phone number and e-mail address for any questions, etc. Cost: $25 per item. Call for quantity discounts. Item for sale: Yes ___ No ___ Hard copy needed: Yes ___ Phone call ($5.00 extra) ___ E-mail ___ Note: This is an estimate only. Market will vary from week to week. Appraisal only as accurate as you describe item, photos may not show actual condition. Payment - $25 per item. We accept Visa/MC/AmEx/Discover and checks/money orders. Check ___ Amount Enclosed: $_________ Credit Card __________________ Card Number _____________________ Name on Card _________________ Expiration __________ DESCRIPTION AND CONDITION: (Use additional page if needed) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________