PROFESSIONAL SPORTS AUTHENTICATOR P.O. Box 6180, Newport ...

PROFESSIONAL SPORTS AUTHENTICATOR P.O. Box 6180, Newport Beach, CA 92658 (800) 325-1121 ? (949) 833-8824 ?

Visit for current information including turnaround times, pricing, etc.

CARD SUBMISSION # 8468580

Customer Name: Customer #:

o q q RETURN SHIPPING ADDRESS (print clearly) Check if permanent change of address

Residential Business

PSA USE ONLY

SERVICE_______________________ QTY ______________DV___________

_NAME_________________________________________________________ PHONE ( _____ )_________________________ _ADDRESS_______________________________________________________ EMAIL_________________________________ _CITY, STATE, ZIP_______________________________________________________________________________________

ORDER #_______________BOX________ ITEM #____________________________ INV TYPE__________________________ DATE RECEIVED____________________

1. TYPE OF SUBMISSION: q Grading q Review q Reholder (Select one per form)

2. HOLDER SIZE: (Select one per form) qREGULAR (2 11/16" x 3 13/16" and under)

THICK/PATCH TALLBOY CARDS (3 1/2" x 5 1/6")

q SUPERSIZED (under 4 1/4" x 10") & T3

FOR COMPLETE HOLDER SIZE DESCRIPTIONS, VISIT

q COINS/PINS

qJUMBO (over 6 1/4" x 8 1/4" up to 8 1/2" x 11")

Additional $30 holder charge may apply. (Holder charge not applicable for Reholder/Custom Encap)

3. S ERVICE LEVEL: (Select one per form) ?

Select Service Level based on the Declared Value per item listed. The individual Declared Values cannot exceed the maximum per Service Level chosen. You may select a higher Service Level for a quicker turnaround. Visit pricing for current estimated turnaround.

qREGULAR. . . . . . . . . . . . . . . . . . . . . . . . . . . . $100

Maximum declared value of $999.

qECONOMY (NOT AVAILABLE). . . . . . . . . . . . . $50

Maximum declared value of $499.

q REHOLDER ? Re-encapsulation of PSA-graded

trading card

q PREMIUM 10. . . . . . . . . . . . . . . . . . . . . . . $10000

Declared value of $250,000 or higher.

q PREMIUM 5. . . . . . . . . . . . . . . . . . . . . . . . . $5000

Maximum declared value of $249,999.

q For a declared value of $500,000 or higher. . . . . $500 q Maximum declared value of $499,999 . . . . . . . $250 q M aximum declared value of $99,999. . . . . . . . .$100

q PREMIUM 3. . . . . . . . . . . . . . . . . . . . . . . . . $3000

Maximum declared value of $99,999.

q PREMIUM 2. . . . . . . . . . . . . . . . . . . . . . . . . $2000

Maximum declared value of $49,999.

q M aximum declared value of $19,999. . . . . . . . . . $50

q Maximum declared value of $19,999.

All T3 & Supersized holders must be submitted at this service or higher. . . . . . . . . . . . . . . . . . . . . . . . . . $35

q PREMIUM 1. . . . . . . . . . . . . . . . . . . . . . . . . $1000

Maximum declared value of $24,999.

q Reholder for Jumbo holders with maximum declared value of $4,999 . . . . . . . . . . $30

q WALK-THROUGH. . . . . . . . . . . . . . . . . . . . . . $600

Maximum declared value of $9,999.

q R eholder for Standard & Tallboy holders with maximum declared value of $4,999. . . . . . . . . . . $10

q SUPER EXPRESS. . . . . . . . . . . . . . . . . . . . . . $300 q OTHER _____________________________________

Maximum declared value of $4,999.

q EXPRESS. . . . . . . . . . . . . . . . . . . . . . . . . . . . $150

Maximum declared value of $2,499. (all T3s must be submitted at this service level or higher)

T3 cards must be submitted under Supersized holder size and Express Service Level or higher. Failure to separate Type of Submission, Holder Size, and Service Levels as noted will result in additional charges and cause significant delays in processing your order.

Autographed cards dated pre-1998 and/or those not directly from the manufacturer must be sent through Card and Autograph Dual Service (fee may vary depending on card value, see listed restrictions and requirements). Autographed cards dated 1998 and later (direct from manufacturer) can be sent through any of the services listed above (note restrictions and requirements for each level). Cards submitted at the Regular and Economy service level that are 6.25" x 8.25" up to 8.5" x 11" in size will require a Jumbo holder and incur an additional charge of $30.

4. SERVICE LEVEL. . . . . . . . _________ x $__________ = $___________

# of items

grading price

subtotal

JUMBO HOLDER. . . . . . . . _________ x $_____3_0____ = $___________

# of items

jumbo holder

subtotal

5. RETURN SHIPPING (per order) -- Select One: q Domestic Return Shipping (see chart on reverse) q International Return Shipping (see Int'l. chart on reverse)

= $___________ = $___________

Alternate Return Shipping

(Must provide your own FedEx or USPS Express Mail account and insurance coverage. If acct info & selections are on file with PSA, please write "On File".)

q FedEx/USPS Express Mail Account #____________________________

Declared Value limit per package (Required):_____________________________ Purchase FedEx Insurance? o Yes $_______ o No Signature Required? o Yes o No o Sat. Delivery o Pri-Overnight am o Std-Overnight pm o 2-Day o 3-Day o Ground

q Pick Up (by approval only)

6. VOUCHER/CREDIT ON ACCOUNT ? $___________

7. TOTAL CHARGES . . . . . . . . . . . . . . . . . . . . . . . . . . = $___________

USD

METHOD OF PAYMENT

q q q q q Cash Credit Card LOC CCOF Check/Money Order #__________

Cardholder's Name

Card Number Exp. Date ____________________ Cardholder's Signature

Form not valid after 12/31/21

QTY. CATEGORY EX. 1 Baseball

SET NAME Bowman Chrome

YEAR CARD #

2011 175

CARD NAME Mike Trout

VARIETY (If Any)

CURRENT CERT. #

(Reviews, Reholders and Crossovers)

MIN. GRADE (Required for

Crossovers)

NO QUALIFIER

DECLARED VALUE

Blue Refractor

$250

1

M

2

M

3 4 5 6 7 8 9 10

PSA IS NOT RESPONSIBLPESAFOWRILALNNYODTABMEARGEESTPOONCSAIRBDLSESFOUBRMINITCTOEMDPILNETHEARODRPINLAACSCTUICRATOTEPOLRODADERESR.S OR CARD SAVER II.

M M M M M M M M

11

M

12

M

13

M

14

M

15

M

All charges must be paid in advance before PSA can process your order. Incomplete or illegible submission forms will delay turnaround time. PSA reserves the right to correct your submission form to reflect its current authentication and shipping prices. If items are submitted for services for which they do not qualify, signature below authorized PSA to correct the order and make any additional charges that may apply. All authentication charges are applicable regardless of outcome.

I HAVE READ AND AGREE TO THE PSA TERMS AND CONDITIONS SET FORTH ON THIS FORM. I ACCEPT FULL RESPONSIBILITY FOR COMPLETELY AND ACCURATELY FILLING OUT THE SUBMISSION FORM(S).

AUTHORIZED SIGNATURE (REQUIRED)

Order will not be processed without signature

DATE

TOTAL DECLARED VALUE $_____________ (REQUIRED)

Turnaround time does not begin until order has been entered into the grading system. All terms and conditions are subject to change. For up-to-date information, visit .

DOMESTIC RETURN SHIPPING & INSURANCE RATE CHART

Number of Items

$1 ? $1,000

$1,001 ? $5,000

TOTAL DECLARED VALUE

$5,001 ? $15,001 ? $25,001 ? $50,001 ? $75,001 ? $15,000 $25,000 $50,000 $75,000 $100,000

$100,001 ? $150,001 ? $150,000 $200,000

1 - 8

$14.00

$29.00

$37.00

$44.00

$56.00

$64.00

$79.00

$120.00 $131.00

9 - 25

$20.00

$35.00

$43.00

$47.00

$63.00

$78.00

$93.00

$130.00 $151.00

26+

add .25 per item

add .25 per item

add .25 per item

add .25 per item

add .50 per item

add .50 per item

add .50 per item

add .50 per item

add .50 per item

Declared Value over $200,000 ? Add $20 for each $50,000 over. *Packages over $200,000 will be a two package shipment and could be subject to additional return shipping changes.

INTERNATIONAL RETURN SHIPPING Insurance Included ? $100,000 Maximum

.CANADA

. ALL OTHER

1 - 10 items $46.00 REGIONS/COUNTRIES

11 - 20 items $50.00 1 - 10 items $55.00

21 - 30 items $54.00 11 - 20 items $60.00

31 - 50 items $59.00 21 - 30 items $65.00

51 - 60 items $69.00 31 - 40 items $70.00

Over 60 - $1.25 per item 41 - 60 items $80.00

EUROPE

Over 60 - $1.25 per item

1 - 10 items $53.00 11 - 20 items $58.00

Specific carrier

21 - 30 items $60.00 31 - 40 items $70.00 41 - 60 items $75.00

requests may result in additional charges.

Over 60 - $1.25 per item

1. Print your name, customer number, return shipping address, email address and phone number in the space provided. For changes in return shipping address, contact Customer Service before order completes the grading/authentication process.

2. Select the Type of Submission, Holder Size, and Service Level. Only one selection from each category is permitted per submission form. Please visit to view current PSA holder sizes. Any item requiring a Jumbo holder will be subject to an additional $30 holder charge, excluding Reholder Services and custom encapsulation.

GRADING: For raw cards. You may, but are not required to, specify a minimum acceptable grade. Cards graded below minimum grade will not be holdered; however, the full grading amount will be charged.

SUBMISSIONINSTRUCTIONS

REVIEW: For cards previously graded by PSA that you feel might be worthy of a higher grade. Submit them in their current PSA holders.

REHOLDER: For any PSA-encapsulated card that you simply wish to have re-encapsulated using our most current holder/label style. Please note: All cards will be automatically reholdered UNLESS (1) the sonic weld on the PSA case shows signs of tampering or (2) the PSA case is fractured over the card itself. If the case is fractured over/ near the card, it will be examined raw to ensure it has not sustained damage and that the original grade is still valid.

3. List the description of each item in order from smallest holder size to largest. For multiple cards of the same type (same year, set, number, and variety), you may list total quantity and write on one line. On

lines listing more than one item, add together the declared value of all items listed on the line and enter total on "Declared Value" column. The Declared Value is your estimate of the value of the item after it has been authenticated/graded by PSA. We understand you will not know the true value of the item until it has been graded, so we ask that you form a realistic, educated estimate based on your own research, keeping in mind that the Declared Value acts as a maximum value in the event of a claim related to the item while at PSA, for shipping insurance purposes, and to determine the appropriate Service Level and price. For more information regarding Declared Value, refer to the FAQ on PSA's website at resources/faq#104.

Please note: there is a maximum of 500 cards per order, please split

larger orders into quantities of 500. Each order of 500 cards will require separate submission forms and Return Shipping.

4. No Qualifiers (NQ): Cards that have significant flaws will receive "qualified" grades (see definitions online at ). If you select this box and your card is determined to have a qualifier, your card will be graded with a lower straight grade. For example, what would be graded an `8 OC' might be graded a straight `6.' Please note: Some qualifiers may not be removed.

5. Calculate Service Level/Jumbo Holder Subtotal and Return Shipping (see rate chart). You must remit return postage for EACH order unless you have your own shipping account with Federal Express or USPS Express Service.

6. Total Charges and mark Method of Payment. Include check, money order or credit card info. You must include payment or your order will not be processed. Remit payment in USD.

7. Read terms and conditions below. Sign and date the front of the form. Keep a copy for your records. Your order will not be processed unless the submission form is signed.

8. Place each card in a flexible plastic pouch, such as a "Card Saver I." Pouch must be sturdy enough to protect item, but flexible enough

to allow us to remove item safely. Do not use hard acrylic holders, screwdowns or top loaders.

9. Package cards and submission form carefully. To help expedite service, service level name must be marked clearly on the outside of the package. If submitting multiple orders in the same package, please mark the outside of the package with the highest service level. Failure to do so may result in delays.

10. TURNAROUND TIMES: The turnaround times listed on pricing are estimates and only include Business Days. While our staff works extremely hard to process submissions within the time frame listed, the turnaround times are not guaranteed. During the week of the National Sports Collectors Convention, turnaround times will be impacted. Check the show schedule for the specific dates.

11. Packages to PSA: United States Postal Service (USPS) and F ederal Express (FEDEX) are the only carriers accepted. We do not accept items sent UPS, DHL, or any other shipping company. No exceptions. YOU ARE RESPONSIBLE FOR INSURING ALL PACKAGES TO US.

a.U SPS to: PSA, P.O. Box 6180, Newport Beach, CA 92658

b.F EDEX Express Service to: PSA, 1610 E. St. Andrew Place, Suite 150, Santa Ana, California 92705

c.F EDEX Ground Service to: PSA, 1610 E. St. Andrew Place, Suite 150, Santa Ana, California 92705

12. Packages from PSA (Return Carrier):

a.A ll orders are returned fully insured with signature required.

b.F EDEX/USPS Express Mail: If requested, you must have your own shipping account number and insurance coverage.

c.D o not send postage stamps, shipping materials or pre-paid postage labels for the return of your package.

d.International shipments requesting specific shipping carriers, may be charged additional Shipping charges.

e. For international shipments, the customer is liable for any duties and taxes assessed on the shipment to and from PSA.

f. Contact Customer Service if delivery of your returned package is not made in 14 days of the shipment date.

13. All terms and conditions are subject to change. For a complete description of all PSA services and to view a list of the items PSA authenticates and grades, please visit .

PSA TERMS & CONDITIONS

By signing the front side of this form, Customer acknowledges that they have read the PSA Grading Terms and Conditions (the "Agreement") set forth below and agrees to abide by this Agreement, and further agrees that PSA is entitled to rely upon and benefit from this Agreement.

1. PSA will endeavor to grade cards within the time frame, if any, offered as part of a PSA grad ing service. However, PSA will have no liability whatsoever to Customer for incidental or consequential damages due to PSA's failure to grade any cards within any time frame. All days are business days.

2. PSA will not grade cards which bear evidence of trimming, recoloring, restoration or any other form of tampering, or are of questionable authenticity, and Customer agrees not to knowingly submit any such cards. Customer agrees that in the event PSA rejects any cards for grading, PSA shall not refund the amount paid by Customer because the determination to reject a card requires a review by PSA's graders and authenticators.

Customer represents and warrants that it has no knowledge and no reasonable basis to believe that any card submitted for grading has been altered in any way or is not genuine. For purposes of this Agreement, "altered cards" shall have the meaning set forth in the applicable Dealer Agreement or PSA Collectors Club Agreement by and between Customer and PSA (the "Customer Agreement"). If Customer has not entered into the Customer Agreement, Customer hereby agrees to be bound by the terms of the Customer Agreement, a copy of which can be found at join, and Customer's signature on this Agreement shall constitute Customer's signature on the Customer Agreement. Customer reaffirms its obligations with respect to Doctored cards set forth in the Customer Agreement.

3. Grading involves individual judgments that are subjective and require the exercise of professional opinion, which can change from time to time. Therefore, PSA makes no warranty or represen tation and shall have no liability whatsoever to Customer for the grade assigned by PSA to any card, except pursuant to PSA's Financial Guarantee of Grade and Authenticity. Amount paid to PSA is NON-REFUNDABLE once the item begins the authentication and/or grading process.

4. An autographed item submitted under the PSA card grading and autograph authentication combination service must pass both autograph authentication and card grading authentication in order to be encapsulated. For example, a card that is deemed altered in any way will not be encapsulated even though the autograph may be genuine. In addition, if the card is deemed original and unaltered yet the autograph does not pass inspection, then the card may not be encapsulated. There may be very rare exceptions to the rule on a case by case basis (in cases where the autograph and card are deemed authentic but the card has been altered in some fashion). In a rare case where an authentic card has been

?2021 Collectors Universe, Inc.

altered, PSA may choose to label the card "Authentic" since the card cannot have a grade assigned. The final determination as to whether a card is encapsulated under these conditions is at PSA's sole discretion. Amount paid to PSA is NON-REFUNDABLE once the item begins the authentication and/or grading process.

5. PSA will exercise reasonable care in handling cards submitted for grading, review, or reholdering. However, if PSA determines that Customer's card was lost or damaged while in PSA's possession, Customer will be compensated based upon the fair market value of the card as determined by PSA standard procedures which may include filing a claim with our insurance carrier. The declared value you stated on the front of this form is for estimating the insurance coverage only, and the fair market value of the card may be less than your declared value. IN NO EVENT SHALL THE TOTAL LIABILITY EXCEED THE DECLARED VALUE OF THE CARD. Such compensation shall be Customer's exclusive remedy for any loss or damage. PSA reserves the right to decline your Declared Value and to require you to pay for the accurate Service Level as a condition of completing the authentication and grading process. For more information regarding Declared Value, refer to the FAQ on PSA's website at resources/faq#104.

6. Customer must inspect all cards immediately upon receipt and PSA disclaims any liability for damage or discrepancies or errors, including, but not limited to, errors in the description of the card unless reported to PSA within five (5) days of Customer's receipt of the card(s). Customer agrees to return any incorrectly described card to PSA upon request for correction and agrees to indemnify and hold PSA harmless from any and all losses and/or claims caused by the circulation or sale of incorrectly described cards.

7. Customer agrees (a) to pay to PSA all pricing and other charges when due; (b) that any delinquent balances shall accrue interest at the rate of 10% per year until paid (or, if less, the maximum interest rate permitted by applicable law); and (c) that PSA shall have a security interest in the items submitted, as well as in any other property of Customer in the possession of PSA or its affiliates (collectively, the "Property"), to secure payment thereof. Customer hereby grants to PSA an assignment of and lien against the Property in the amount of any pricing and other charges due and payable pursuant to the terms of this Agreement. Customer hereby authorizes PSA to file, at any time on or after the date such pricing totals and other charges become due, appropriate uniform commercial code financing statements in such jurisdictions and offices as PSA deems necessary in connection with the perfection of a security interest in the Property.

8. PSA shall have no liability whatsoever to Customer, or any third party for whom Customer may be acting, (i) for any personal injury or (ii) any damage to any card, or otherwise, resulting from the breaking open of a PSA card

holder, or for any damage to any card that PSA can reasonably demonstrate occurred while the card was not in the custody or control of PSA including, but not limited to, loss or damage to cards while being shipped to PSA, or while being shipped by PSA to Customer by a method selected and paid for by Customer.

9. Except as expressly set forth herein to the contrary, PSA DISCLAIMS ANY AND ALL WARRANTIES, EXPRESSED OR IMPLIED, REGARDING PSA'S GOODS AND SER VICES, INCLUDING, BUT NOT LIMITED TO, THE WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.

10. Notwithstanding anything to the contrary contained herein, except with respect to the remedies under the PSA Financial Guarantee of Grade and Authenticity set forth at PSAcard. com (the "Guarantee"), THE MAXIMUM AGGREGATE LIABILITY THAT PSA SHALL HAVE TO CUSTOMER, OR ANY

THIRD PARTY FOR WHOM THE CUSTOMER MAY BE ACTING, ARISING FROM ANY CAUSE, ACT, OMISSION OR OTHER CIRCUMSTANCE, SHALL IN NO EVENT EXCEED THE GRADING CHARGES OR LESS ACTUALLY PAID BY CUSTOMER FOR THE GRADING SERVICES RENDERED BY PSA WITH RESPECT TO THE ITEMS SUBMITTED FOR GRADING HEREUNDER. IN NO EVENT SHALL PSA OR ANY OF ITS AFFILIATES, OR ANY OF ITS OR THEIR RESPECTIVE EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS, BE LIABLE TO CUSTOMER OR ANY OTHER PARTY FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

11. In the ordinary course of its grading operations, PSA (i) compiles data regarding each card submitted for grading, including, but not limited to, data relating to the identity, production, condition and grade of the card (the "Data"); and (ii) may take, or have taken, one or more digital or other types of photographs, images or reproductions of each such card (collectively, the "Images"). In consideration for the grading services being provided by PSA, Customer, on behalf of itself and any third party for whom Customer may be acting, hereby authorizes PSA (i) to compile and maintain such Data with respect to each card submitted hereunder for grading; and (ii) to take, or cause to be taken, one or more Images of each such card, and further agrees that PSA will be the owner of such Data and all such Images and that PSA may use and exploit such Data and the Images for commercial and any other purposes, as PSA in its sole discretion deems appropriate, including, but not limited to, the p ublication and republication or reproduction in or on any media, of such Data and Images. Without limiting the generality of the foregoing, Customer, on behalf of itself and any third party for whom Customer may be acting with respect to this agreement,

PSA Customer Service (800) 325-1121

unconditionally and irrevocably transfers, conveys and assigns to PSA any and all current and any hereafter acquired rights, title and interests (including, without limitation, rights in copyright, patent, trade secret and trademark) that Customer or any such third party may have in or to the Data and the Images (on whatever media or in whatever form such Images may be reproduced or published).

12. If any cards are being submitted for a third party, Customer represents and warrants that such third party has agreed and accepted this Agreement and has signed a duplicate copy hereof where indicated. Customer agrees to provide that third party-signed copy to PSA at any time upon its request.

13. This Agreement is delivered and accepted in the State of California and it is the intention of the p arties that it be governed by and construed in accordance with the substantive laws of that State, without regard to conflicts of laws principles. The parties hereby consent to personal jurisdiction of the courts of the State of California with respect to any legal action to enforce the terms and conditions of this Agreement or otherwise arising under or with respect to this Agreement, and agree that the Superior Court of California, County of Orange, or, if applicable, federal District Court sitting in the County of Orange, State of California, shall be the sole venue, and the State of California shall be the sole forum, for the bringing of such action. Each of Customer and PSA agrees that the prevailing party shall be entitled to an award of its reasonable attorney's fees, costs and expenses.

14. The terms and provisions in this Agreement and the Customer Agreement, if applicable, constitute the entire agreement of PSA and Customer (and any third party for whom Customer may be acting) regarding, and supersede all prior agreements and understandings (written or oral) between or among such parties relating to, the subject matter hereof. If it is determined that there are any inconsistencies between this Agreement and the Customer Agreement, then this Agreement shall control. If any term or provision of this Agreement is determined, by a final and non-appealable ruling or order of a court of competent jurisdiction, to be invalid or unenforceable under applicable law, such invalidity or unenforceability shall not affect the validity or enforceability of any of the other of the terms or provisions of this agreement. Each party shall execute and deliver such additional documents and instruments as any other party may request to better evidence or effectuate the agreements contained herein, including the assignment of rights set forth in Section 11, and procedures, and further agree that PSA is entitled to rely upon and benefit from those terms and procedures.

105303 (card) Rev 02/21

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