ONLINE BIDDER APPLICATION SPRING 2018 Name: _______________________________________________________________________________ DVAuction User ID #: ____________________ DVAuction Username: __________________________ Billing Address: _______________________________________________________________________ City: _______________________________ State: ___________________ Zip: ___________________ Billing Phone #: ____________________________ Cell Phone #: _______________________________ Email Address: ________________________________________ AQHA #: ______________________ APPROVAL OPTION #1 – Pre Wiring of Funds Bank Account #: ________________________________________________________ Bank Name: ___________________________________________________________ Address: ______________________________________________________________ City: ______________________ State: __________________ Zip: _______________ Phone: ___________________________ Fax: ________________________________ Bank Contact: __________________________________________________________ AMOUNT WIRED $______________________________________________________ U.S. Funds To: MIDWEST INDEPENDENT BANK 910 Weathered Rock Road ABA# 086505273 Jefferson City, MO 65101 For Credit To: ERICSON STATE BANK - 427 Central Ave. – Box 98 Account # 750087 Ericson, NE 68637 ABA# 104113945 (308) 653-5441 For Further Credit to: Pitzer Ranch Horse Sale Account # 137018 48794 Cedar River Rd. Ericson, NE 68637 IF ANY QUESTIONS OR PROBLEMS WITH THE TRANSFER OF FUNDS PLEASE CONTACT: Ericson State Bank - (308) 653-5441 APPROVAL OPTION #2 – Credit Card Approval Credit Card # ____________-____________-____________-____________ Expiration Date: ____________ Code: ____________ Card Limit $____________ ALL PURCHASES, FEES, PLUS A 3% TRANSACTION FEE WILL BE CHARGED TO THIS CREDIT CARD I authorize above payment information

Signed By: ___________________________________

ADDITIONAL HELPFUL INFORMATION REQUESTED BY PITZER RANCH Driver’s License State of Issue: ______ Driver’s License #: ______________________________ Name of Transporter: ____________________________________________________________ Contact Person: _________________________________ Phone #: ______________________ PLEASE HAVE REGISTRATION INFORMATION AVAILABLE FOR PITZER RANCH WHEN SETTLING PLEASE COMPLETE FORM & FAX BACK TO DVAUCTION BY: 5:00 PM CST April 20, 2018 DVAUCTION FAX # (402) 474-5561