LOAN AGREEMENT WITH BINGHAM-WAGGONER HISTORICAL SOCIETY

P.O. Box 1163, Independence, Missouri 64051

Name ________________________________________

Date _________________________

Address ______________________________________

Phone ________________________

Dates of loan wall-to-wall ________________________

to __________________________

Purpose of loan _____________________________________________________________

Who transports? ____________________________

How? ___________________________

Insurance Company __________________________________________________________

I/We hereby loan to the Bingham-Waggoner Historical Society the following items under the conditions set forth on the other side of this form:

ITEM NO. DESCRIPTION CONDITION VALUE

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_______________________________________

Lender

Approved:

BINGHAM-WAGGONER HISTORICAL SOCIETY

By: _______________________________________

Date: __________________________

RELEASE

I hereby release the above-listed items on _________________________________________

Name: _______________________________________ for the Bingham-Waggoner Society.

I hereby acknowledge return of the above-listed items.

Name: _____________________________________ Date: ________________________

CONDITIONS OF LOANS TO THE BINGHAM-WAGGONER HISTORICAL SOCIETY

It is understood that the items listed in this loan agreement will remain in the condition received and will not be repaired, restored, cleaned, altered or added to in any manner.

All damages, if any, to items will be reported to the owner immediately.

Bingham-Waggoner Historical society agrees to use the items only in the manner and for the purpose set forth in this Agreement and will not lend any item to a third party unless agreed in writing.

The Society will not be responsible for moving any item to and from the premises unless agreed in writing by both parties. If the lender terminates the loan before the agreed time, the lender will be responsible for moving said item.

The Society will surrender the item to the lender only upon the lender's signing the Release on the Loan Agreement and indicating that the loan has been returned. If the Lender dies or cannot receive the item personally, the estate or a third party must have documented authority to receive the loaned item.

The items are on loan for the dates indicated. In the even that the lender does not pick up his/her property, or cannot receive it, the society maintains the right of disposing of the items or charging a reasonable storage fee ninety days (90) after the ending wall to wall date shown on the Loan Agreement. A registered letter is considered an adequate notice of the Society's attempt to notify the lender of its attempt to return the loaned item.

PLEASE NOTE ANY EXCEPTION: ___________________________________

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