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  Print this form and send with photo to: 955 E. Ball Rd. ,Anaheim, CA 92805

USED EXHIBITS - QUESTIONNAIRE
Date: ______________________________Name of Seller:__________________________
Phone: ______________________________ Fax: ______________________________
E-MAIL: ____________________________________
Desired Sale Price: ____________________ (Excluding Broker's fee)
Exhibit Size: _________________________ (Photograph of exhibit required)
     __ In-line     __  Peninsula        __  Island

Condition of Exhibit:

__ Excellent condition __  Good condition __  Fairly good condition, needs some repair

Crates for Storage/Transportation:
    __  Yes       Number of Crates: __________________________
    __  No        Method of storage/shipping:____________________

Exhibit Features: (Please check all boxes that apply)

__  Rotating Sign __  Storage areas
__  Light Boxes       __  Display cases
__  Turntable    __  Lighting (please specify below)
__  Reception counter  __  Private conference room
__  Semi-private conference area     __  Carpet
__  Special electronics, i.e., T.V., V.C.R. (please specify below)  

  Special comments:__________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

If you choose to post your used exhibit, the fee is $100.00 for three months,  prepaid on a quarterly basis.
We accept checks, Visa and Master Card.

DISCLAIMER NOTICE:
M-DOC EXHIBITS DOES NOT WARRANT ANY OR ALL USED EXHIBIT COMPONENTS BEING POSTED FOR SALE ON THIS
WEB SITE.  IT IS THE SOLE RESPONSIBILITY OF THE SELLER TO REPRESENT ANY PERTINENT FACTS FOR SALE
OF AN EXHIBIT.  ASSESSMENT AND PAYMENT OF ANY APPLICABLE SALES TAX, IS THE RESPONSIBILITY OF THE SELLER.

Authorization to post information on M-DOC’s used exhibit Web site:

_____________________________________________
Print Name of Signature below
_____________________________________________    _________________________
Authorized signature of Company Representative                     Date