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

Return Shipping Includes Insurance & Tracking with Signature Confirmation Required. $39.99 Flat Rate. Purchase at the realnna Store ( Included with your first regular submission fee of $59.98. Additional coins @ $19.99)

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Signed	Date

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 to your cart. First one @ $59.98 ( includes shipping ) ALL additional coins are $19.99 calculated at checkout ) Then add the total number of Variation submissions (if any) @ $39.99 to your cart. 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. Values of $5001-10,000 MUST add a HIGH VALUE Submission to the cart. All submissions MUST include at least 1 STANDARD SUBMISSION (Includes shipping) All Coins 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