FEE
CALCULATION
______ coins
x $15.00 per coin = $__________
(If your total
value is $2000 or less.)
Includes return
postage and Insurance.
Please add 1%
of total value over $2000 for added insurance.
Sample:
A total value of
$5000 would cost $15 per coin + 1% of $3000 (value over
$2000) for an additional cost of
$30.00.
$___________
over $2000 x .01 = $__________
Total
enclosed: $_________________
(Includes
postage, packaging and insurance)
(send check or
money order with submission)
Please allow
approximately 21 days for return.
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SUBMITTER
INFORMATION
NAME:
_____________________________________
ADDRESS:
__________________________________
CITY:
______________________________________
STATE, ZIP:
_________________________________
PHONE:
____________________________________
EMAIL:
_____________________________________
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