For Office Use Only

Submission Form
James Spence Authentication, LLC DIR
3223 N.W.10th Terrace, Suite 605 2 Sylvan Way Suite 102 Submission # W205232
Fort Lauderdale, FL 33309 Parsippany, NJ 07054-3809
954-380-8670 888-4-JSPENCE 973-898-1300 Source:
Fax: 954-380-8673 Fax: 973-898-1301
florida@SpenceLOA.com info@SpenceLOA.com
Date / Time:
www.SpenceLOA.com CC Approval

Name and/or Company

Ship to Street Address (NO PO BOX)
City, State, Zip
Email:
Business Phone: (circle one) Dealer Auctioneer Collector Non-Collector

Cell Phone: Ask us about scheduling a House Call or Store Visit.

All fees must be paid in advance before we can process your order. Incomplete or illegible submission forms will delay turnaround time.
We reserve the right to correct your submission form to reflect our current authentication fees.
All fees are applicable regardless of outcome of authentication.
AUTHENTICATION FEE FOR OFFICE DECLARED
Qty ITEM TYPE AUTOGRAPH THEME
(Check One Service) USE ONLY VALUE

Who Signed Your Item? Amount Basic Cert LOA Certification #

Thank You, TOTAL AUTHENTICATION FEE(s)/VALUE $ $

UPS Return Shipping Method ± see rate chart on reverse
All Shipments with a total declared value of $1000 or 1.Total Authentication fee(s) $
more will be returned Signature Required
2. Shipping  /  Handling  /  Insurance  (see  reverse) $
Ƒ ND Air Saver Ƒ2 nd
Day Air Ƒ 3 Day Ƒ Ground
3.Total  Charges  (sum  1  &  2)   $
OR use your UPS Acct ² enter here #  

#
For FedEx, you MUST USE YOUR ACCT
  Method of Payment
Ƒ  Priority                        Ƒ  Standard Ƒ 2nd Day Ƒ Exp Saver PIE - Basics
**MUST CHECK ONLY ONE** Check or Money Order Cash $
OR on your (LOA)
Do  you  want  a  certification  label  on  your  item(s)?     Letter(s)? # 5HF¶GE\

The pressure sensitive alpha numeric sticker cannot be removed without

voiding. JSA will assume discretion if the choice is not made by the submitter. ƑVisa Ƒ MC Ƒ Discover

I have read and agree to the JSA authentication terms and Card #
conditions on the back of this form. Exp Date CVC Code
Cardholder Name (sign here)
AUTHORIZED SIGNATURE
DATE
(mandatory)

Merchandise Pick-Up Authorized Signature Date: __________________

 James Spence Authentication, LLC Submission Form Instructions
1. Confirm that your autograph(s) are listed on the fee schedule. If not, email or call our office for a quote Info@SpenceLOA.com, 954-380-8670
or 973-898-1300.
2. Enter the quantity, item type, autograph theme and authentication fee. Items valued over $200.00 require an LOA.
3. Enter a declared value, this is for insurance purposes only. We don’t advise on valuation.
4. Select a return carrier, UPS or FedEx, according to the instructions on the front of this form.
5. Select placement for your tamper evident label. Please pick only ONE.
6. Enter payment information CLEARLY & LEGIBLY. Failure to do so will delay processing of your submission.
7. Pack your item securely and include your submission form and remember to keep a copy for yourself. We will not proceed with our service until
a signed submission form is received.
8. Send your item(s) to: James Spence Authentication, LLC (Florida Office) 3223 N.W. 10th Terrace, Suite 605, Ft. Lauderdale, FL 33309
–OR–
James Spence Authentication, LLC (New Jersey Office) 2 Sylvan Way, Suite 102, Parsippany, New Jersey 07054

Terms & Conditions

1. For purposes of this Submission Form, James Spence Authentication, LLC, its employees, agents, representatives and/or affiliates are referred
to as “JSA”.
2. JSA will endeavor to certify submissions within a reasonable time frame. Certification and authentication may involve a collective judgement that is
subjective and may require the collaboration of professional opinions which may change from time to time. Therefore, JSA makes no warranty or
representation and shall have no liability whatsoever for the time frame to certify a submission nor the opinion rendered.
3. JSA will not be responsible for, nor have an opinion of authenticity, on any item not listed on the submission form and/or accompanied by a JSA result
document.
4. All fees paid to JSA are NON-REFUNDABLE. Any payments made via check which are declared NSF, or uncredited checks issued by customer to JSA
will incur additional assessed bank fees and charges.
5. JSA exercises reasonable care in handling item(s) submitted for authentication. If JSA determines the customer’s item(s) was lost or damaged while
in JSA’s possession, the customer will be credited in the form of a CREDIT VOUCHER in an amount determined by JSA in its sole discretion which
may differ from the customer assigned declared value of the item(s). Any credit issued by JSA will be in the form of a CREDIT VOUCHER that is non-
transferrable and valid for (1) year from the date issued. JSA shall have no liability whatsoever for any loss or damage of any submitted item(s) that is
not in the custody or control of JSA, including but not limited to UPS or FedEx.
6. Customer agrees to immediately inspect all submitted items, submissions and LOA’s (Letter of Authenticity) and report to JSA any damages,
discrepancies or mechanical errors within two (2) business days of receipt. Upon customer’s notification JSA will provide instructions and necessary
steps to resolve. Mechanical errors include, but are not limited to, such errors as incorrect date, designation, name of signer(s) and description of
submission. Customer agrees to indemnify and hold harmless JSA and its affiliates against all losses and/or claims (including attorney’s fees and court
costs) caused by the circulation or sale of a mismarked or inappropriate item or any unauthorized use of a JSA certificate or label.
7. Except as expressly set forth herein, JSA disclaims any and all warranties, express or implied, (including the warranty of merchantability and the
warranty of fitness for a particular purpose) regarding its services.
8. The courts of Morris County, NJ shall have exclusive jurisdiction and venue of any controversy or claim arising out of or relating to any submissions
to JSA and THE PARTIES IRREVOCABLY WAIVE THEIR RIGHTS TO A TRIAL BY JURY WITH RESPECT TO ANY SUCH CONTROVERSY OR
CLAIM. The court shall award to the prevailing party, in addition to any other relief deemed appropriate, the prevailing party’s attorney’s fees and costs
of litigation, whether or not those are otherwise available to the prevailing party by statute.
9. All submission results will be sent by mail. It is against JSA policy to provide results by phone, fax, or email. No exceptions will be made.
10. Any submissions/items held by JSA for a period of 90 days from the date of the submission that has not been paid for will be placed in JSA
storage and may incur additional charges.

U.S. RETURN POSTAGE AND HANDLING FEES- UPS DOMESTIC SHIPPING ONLY
Estimated Value Next Day Air Saver 2nd Day Air 3 Day Select Ground
$0-$499 $79.00 $41.00 $32.00 $22.00
$500-$999 $83.00 $45.00 $35.00 $26.00
$1,000-$1,999 $90.00 $52.00 $43.00 $35.00
$2,000-$2,999 $98.00 $60.00 $50.00 $43.00
$3,000-$4,999 $113.00 $75.00 $65.00 $58.00
$5,000-$6,999 $128.00 $90.00 $80.00 $73.00
$7,000-$9,999 $150.00 $112.00 $104.00 $99.00
$10,000-$14,999 $188.00 $150.00 $140.00 $136.00
$15,000-$19,999 $225.00 $187.00 $178.00 $168.00
$20,000-$24,999 $263.00 $225.00 $215.00 $219.00
$25,000+ CALL CALL CALL CALL

For shipments to Canada and Overseas ± We will use the U.S. Postal Global Express Service for return
shipping. Go to https://postcalc.usps.com/ or call our office for pricing.
* Residential addresses must apply an additional $4.00 to above charges.
* Various zip codes may incur additional charges.
JSA Customer Service Toll Free Line 888-4-JSPENCE (888-457-7362)
www.SpenceLOA.com info@SpenceLOA.com florida@SpenceLOA.com