COIN #	QTY	DATE/MINT	DENOM	VARIETY (IF ANY)	VALUE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL VALUE	XXXXXXX	XXXXXXX	XXXXXXX	XXXXXXX

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Instructions for payment: When you click the Payment Processing button you be taken to the National Numismatic Authority store. There, you will add the total number of standard submissions @ $19.99 to your cart. Then add the total number of Variation submissions (if any) @ $39.99 to your cart. Shipping will be automatically be added. Proceed to checkout and pay with numerous options. Print the submission form, fill it out, Sign/date and mail it with your coins (in flips and labeled) to: realnna PO Box 343 Newalla OK 74857-0343

Read more: Maximum value per submission is $5000. All submissions must be in flips, labeled (paper tag in unused half of flip is OK) with the corresponding # on the submission form. Please print this page, complete and return with submission TO: realnna PO Box 343 Newalla OK 74857-0343