collectorscorner.org store: Printable Coin Supply Order Form: REV.-1/1/2009
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PLEASE PRINT ---- _E-Mail Address: _____________@_____________________ NAME:_______________________________________________ ADDRESS:____________________________________________ CITY:_______________________STATE:___________________ZIP:__________________ |
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| ITEM NUMBER | DESCRIPTION | QUANTITY | PRICE@ | ||
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| SUB-TOTAL___________ | |||||
| New Jersey Residents Only, please add 7% sales tax on all orders ___________ | |||||
| SHIPPING & HANDLING ( All orders see below ) ___________ | |||||
| All Quarter Map & Oak Frame Orders: (Weight & Oversized) Add EXTRA $2.00___________ | |||||
| OUT of U.S.A. (Canada $20.00) Over Seas ($50.00) un-used postage will be returned___________ | |||||
| ( _ ) Check - - ( _ ) Money Order--( _ ) Credit Card | |||||
| ( _ ) Visa ( _ ) Master Card ( _ ) Amer. Express # _______-_______-_______-_______, | |||||
| exp date: _____/_____, security code: _____, Signature:_________________________ | |||||
| U.S Funds Only:.......TOTAL INCLOSED_______________ | |||||
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