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The form provided by the Eugene Police Department will require the following information: <br />GENERAL RECEIPT FOR CUSTOMERS <br />1. Business name, address and phone number <br />2. Customer name, address and phone number(s) <br />3. Salesperson's initials <br />4. Description of item <br />5. Item number <br />6. Quantity <br />7. Price paid per item <br />8. Total price paid (amount) <br />9. Customer signature <br />10. Date and time of transaction <br />11. Receipt Number <br />ELECTRONIC DATABASE INFORMATION <br />Customer Identification Details <br />12. Name (last, first, middle) <br />13. Birth date (MM/DD/YYYY) <br />14. Current address (street address, city, state and zip <br />15. Customer phone (home /other) <br />16. Type of photo identification and identification number of one of the following <br />identification types: <br />• Driver license number and state of issuance <br />• State issued identification card and state of issuance <br />• U.S. Passport <br />• U.S. Military identification <br />17. Hair color <br />18. Height <br />19. Weight in pounds <br />20. Eye color <br />21. Gender <br />22. Race <br />Prop - Details <br />23. Item class <br />24. Sub class <br />25. Size <br />26. Make <br />27. Model <br />28. Serial number <br />29. Item description <br />30. Color <br />31. Engravings /owner applied number or name <br />32. Quantity <br />Form - Exhibit A <br />