Owner of Collection *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

In the unlikely event we cannot contact you, who is an alternate contact (family member, trusted friend, attorney or business administrator)?

First Name

Last Name

Alternate Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Alternate Contact Phone

(###)

###

####

Is this person aware they are your alternate contact?

Yes

No

Would you like this person included in client-X Gallery communications?

Yes

No

Who is authorized by you to have particular access to collections and collection items stored with X Gallery?

First Name

Last Name

Phone

(###)

###

####

Check all that apply

View and Handle Items

Remove Items from X Gallery

Digital Portal Login

Additional Authorized Person

First Name

Last Name

Phone

(###)

###

####

Check all that apply

View and Handle Items

Remove Items from X Gallery

Digital Portal Login

Additional Authorized Person

First Name

Last Name

Phone

(###)

###

####

Check all that apply

View and Handle Items

Remove Items from X Gallery

Digital Portal Login

Additional Authorized Person

First Name

Last Name

Phone

(###)

###

####

Check all that apply

View and Handle Items

Remove Items from X Gallery

Digital Portal Login