I, _____________________________________ by affixation of my signature hereto, do certify that I have read the Contract/Consignment Agreement and other required Mall forms and understand and agree to the terms and conditions therein. I further certify that I am the possessor of all rights to the items being submitted and that I authorize BlackHills.com to display images and descriptions of these items on The Sturgis-Rally Virtual Mall. I also am aware of the Risks and liabilities that are involved with any form of retail sales and agree to assume those risks that are associated with my product(s). I agree to hold blackHills.com and or the Sturgis-Rally Virtual Mall blameless in the failure of any of my products and if necessary will defend same.

Signed: ________________________________ Date: ____________, 20______

PLEASE PRINT THE FOLLOWING INFORMATION:

Full Name: __________________________________________________________________

Business Name: ______________________________________________________________

Street Address: ______________________________________________________________

P.O. Box: ___________________________________________________________________

City/Township: __________________________ State/Province: _____________________

Postal Code: _________________Country: ________________________

Phone: ______________________________________________________________

E-Mail Address: ______________________________________________________________

PLEASE NOTE: NO SUBMISSIONS WILL BE ACCEPTED WITHOUT THE ORIGINAL SIGNED COPY OF THIS AGREEMENT. PLEASE RETAIN A COPY OF THE SAME FOR YOUR RECORDS.

Mail documents to:

BlackHills.com
511 W. Jackson Blvd.
Spearfish, SD 57783