Trophy Quest Outdoors License Application Form

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1 Trophy Quest Outdoors License Application Form Trophy Quest Outdoors Application Service PO Box 131, Ephraim, UT (435) Complete and send form to Trophy Quest Outdoors. Please keep a copy of this information for your records. PRINT CLEARLY * required fields to submit * Full Name * Male Female * Date of Birth / / * Mailing Address * City * State * Zip * Phone Number (Day) ( ) - * (Cell) ( ) - * Social Security Number - - * Driver s License # and State Hunter Education Number and State * Height * Weight * Hair Color * Eye Color Address Would you like to receive Trophy Quest Outdoors electronic newsletter? Yes No Note: Trophy Quest Outdoors does not share addresses with third parties. You will receive Trophy Quest Outdoors newsletter, special offers or application information. Instructions to unsubscribe come with every . Are any of your applications party applications? Yes No List any other member of your party (if any): (Party applications are a one-draw-all-draw.) FAILURE TO COMPLETE THIS FORM LEGIBLY AND IN ITS ENTIRETY WILL RESULT IN REJECTED APPLICATIONS Preferred Credit Card (You must provide a credit card) Alternate Credit Card (You must provide an alternate credit card) *Your name as it appears on the card (Please Print) * Card Number: * Exp. Date: Security Code ( ) * Billing Address: * City: State: Zip: *Your name as it appears on the card (Please Print) * Card Number: * Exp. Date: Security Code ( ) * Billing Address: * City: State: Zip: State ID #s Provide your state ID # if you have applied in any of these states and would like us to continue applying for you: Colorado ID #: Montana ALS #: _ Kansas ID #: Oregon Hunter/Angler #: Washington WILD ID #: Iowa DNR #: Wyoming Sportsperson ID #: California GOID #: New Mexico CIN #: 1

2 Choose One: Apply me online where available Submit my paper applications where available Choose One: How likely are you to hire a guide? Always guided Guided usually prefer guided hunts Guided sometimes prefer self-guided hunts Never guided Choose One: Which type of unit would you like to apply for? What weapon(s) do you hunt comfortably with? Best Unit, only 1 choice The best unit in the state Trophy Units Top units in the state Above Average Units Above average, mid-range scoring animals Better Odds Representative of the species, average quality *Points Only I do NOT want to draw this year * Other Please specify on each state s section (See below) Archery Muzzleloader Rifle Any Weapon * You will automatically get a point if you apply for a tag and are unsuccessful in the draw. Points Only means you do NOT want to be put in the draw this year, you only want to build points. Power of Attorney TO ALL PERSONS, be it known, that the undersigned, GRANTOR, being an applicant for any and all big game hunts or fishing trips requiring an application, Last Name: First Name: Middle Initial: Does hereby make, constitute, grant, and appoint a limited power of attorney to Trophy Quest Outdoors, LLC of Utah, as his true and lawful attorney-in-fact to sign in the name, place and stead of the undersigned and make charges to his/her credit card for said applications. The grant of power herein contained is given and granted to execute such special hunting/fishing license and permit applications and endorsements of such license and permit funds. My attorney-in-fact hereby accepts this appointment subject to its terms and agrees to act and perform in said fiduciary capacity consistent with my best interests as he/she, in his/her best discretion, deems advisable, and I affirm and ratify all acts so undertaken. This power-of-attorney shall be revoked by disability of the Grantor, and shall otherwise continue in full force and effect until revoked by Grantor in writing. *It is important that you understand that we have a lot of clients and cannot call each client individually at the end of every year. If any of your hunting plans change, it is your responsibility to call Trophy Quest Outdoors and make those changes known. If you do not, Trophy Quest Outdoors will use the same hunting plan established for you from year to year until you notify us otherwise. * Dated this day of, 20 * Applicant Signature (Grantor): Date: * Witness Signature: Date: * Any error made by Trophy Quest Outdoors Application Services entitles applicant to a full refund of application and tag fees for that particular state. No other associated costs will be refunded. 2

3 Please provide us with additional information so we are able to better apply you for hunts. ALASKA Alaskan Resident ARIZONA Arizona Resident Dall Sheep Desert Sheep Coues Deer Antelope Elk Rocky Mtn Sheep Mule Deer Buffalo Specify which species: CALIFORNIA California Resident COLORADO Colorado Resident Desert Sheep Tule Elk Roosevelt Elk Mule Deer Rocky Mtn Elk Antelope * Choose ONE species of elk Specify which species: IDAHO Idaho Resident Choose One: CA Sheep Moose RM Sheep Goat OR Choose Up to Three: Mule Deer Elk Antelope Desert Sheep Elk Moose Goat Mule Deer RM Sheep Antelope Specify which species: IOWA Whitetail Iowa Resident KANSAS Kansas Resident KENTUCKY Kentucky Resident Whitetail Elk MAINE Maine Resident MONTANA Montana Resident Canadian Moose 1 chance- $15 3 chances- $25 6 chances- $35 Blocks of 10 chances- $55 # of Blocks Antelope Moose Buffalo Sheep Goat (If you would like to add Deer and/or Elk to Montana, please call us.) 3

4 NEVADA Nevada Resident NEW HAMPSHIRE New Hampshire Resident CA Sheep Elk Antelope Silver State Tag Desert Sheep Antelope Deer Silver State Tag Mule Deer Elk Silver State Tag Desert Silver State Tag - Specify which species: Canadian Moose NEW MEXICO New Mexico Resident OREGON Oregon Resident Rocky Mtn Sheep Antelope Elk Desert Sheep Mule Deer Oryx Ibex (Specify if you would like Coues Deer as a 2 nd Deer choice.) Antelope Elk Mule Deer Columbian Whitetail Blacktail Deer Mocky Mtn Sheep Californa Sheep Goat - Available for Deer, Elk, Antelope PENNSYLVANIA Pennsylvania Resident TEXAS Texas Resident Elk Desert Sheep _ Additional Information: UTAH Utah Resident VERMONT Vermont Resident Mule Deer Elk Antelope Moose Rocky Mtn Sheep Desert Sheep Goat Buffalo - Specify which species: Canadian Moose WASHINGTON Washington Resident WYOMING Wyoming Resident Moose Sheep Goat - Specify which species: Moose Antelope Sheep Goat Mule Deer Elk Buffalo - Not available for Goat or Buffalo: 4

5 TERMS and CONDITIONS Trophy Quest Outdoors does not guarantee or imply that a permit will be drawn and does not increase the chances that a permit will be drawn by the applicant. Limitation of Liability: In case of any error(s) on the client application that results in rejection of the application, Trophy Quest Outdoors liability is limited to the application fee and service fee charged for said application. Trophy Quest Outdoors assumes no liability for any loss, expense, damage, accident, delay, inconvenience, injury or death which results directly or indirectly from the drawing of any permits and any resulting hunting and related activities, whether successful or unsuccessful, that may be undertaken. Applicant agrees to be responsible for the costs should a license be drawn. Applicant agrees that he/she will be responsible for payment of all license fees should a tag successfully be drawn. Any adult who witnesses an Application Form for a minor will assume all liabilities and fees for said minor. Entirety: This instrument sets forth the entire agreement between Trophy Quest Outdoors and applicant. Should any provision of this Agreement be void or unenforceable, the rest of this Agreement shall remain in full force. This Agreement may not be canceled, altered, or amended except in writing. Choice of Law: Any disputes which may arise between Trophy Quest Outdoors and the applicant arising out of the services provided herein shall be heard solely in the appropriate state or federal court located within the State of Utah and in no other jurisdiction. Applicant specifically submits to the personal jurisdiction of such court within the State of Utah. Applicant agrees that Utah law shall govern the rights and liabilities of the parties. CREDIT CARD INFORMATION Please provide at least one VISA or MASTERCARD since some states do NOT accept American Express. Make sure both of your cards expire AFTER November of the year you are applying in. If your card(s) expires prior to November of the year you are applying in, please list it and contact your credit card company asking them to extend the expiration date. Make sure you call Trophy Quest Outdoors with the new expiration date. It is advised that you notify your credit card company of the individualized state transactions that will appear throughout the year for all of your hunting applications. By doing so, you will be able to ensure that incorrect fraud assumptions do not take place that would freeze your credit card and cause your application(s) to be rejected. As a side note, it is a very good idea to apply for and acquire a credit card that is for hunting/applications only so that there is no possible way that a credit card could be rejected. Trophy Quest Outdoors is not responsible for rejected credit cards. It is also advised that you call and notify us of credit card changes when and if they occur. LIMITED POWER of ATTORNEY with DURABLE PROVISION TO ALL PERSONS, be it known, that the above applicant, GRANTOR, does hereby make and grant a limited power of attorney to Jeremiah Blain, as representative of Trophy Quest Outdoors, and/or any other authorized representative of Trophy Quest Outdoors, and does thereupon constitute and appoint said individuals as my attorneyin-fact. My attorney-in-fact shall have limited powers and authority to do and undertake such acts as herein described on my behalf that I could do personally, with full power of substitution and revocation. Granted are the powers to execute such special hunting license and permit applications and endorsement of such license and permit funds. Granted is the power to charge my credit card for payment, reimbursement or refund of such license and permit funds. My attorney-in-fact hereby accepts this appointment subject to its terms and agrees to act and perform in said fiduciary capacity consistent with my best interests as he, in his discretion, deems advisable, and I affirm and ratify all acts so undertaken. This power-of-attorney shall be revoked by disability of the Grantor, and shall otherwise continue in full force and effect until revoked by Grantor in writing. CONTRACT of CONSULTING, APPLICATION and OUTFITTING SERVICES I CERTIFY that the statements on this application are true and correct and I hereby authorize any involved State Wildlife Department to make further inquiries to verify these statements. I understand the rules of eligibility for application for licenses and permits, I am eligible for the license(s) or permit(s) applied for and I will not apply for the same hunts I have instructed Trophy Quest Outdoors to apply for on my behalf. I UNDERSTAND that my use of the services of Trophy Quest Outdoors does not guarantee or imply that a permit will be drawn and does not increase the chances that a permit will be drawn by the applicant. Use of Trophy Quest Outdoors does not obligate the applicant to book a hunt. By my signature below, I READ, UNDERSTAND, and AGREE to the Terms and Conditions as stated in this application. * Dated this day of, 20 * Applicant Signature (Grantor): Date: * Witness Signature: Date: 5

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