COIN #	QTY	DATE/MINT	DENOM		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 PACKAGE” Includes Insurance & Tracking with Signature Confirmation Required. $39.99 Flat Rate. UP TO 20 COINS and $5000 Purchase at the realnna Store

I Acknowledge that I have read and agree to the National Numismatic Authority’s terms and conditions.
Orders will not be processed without a signature.

Signed	Date
Phone

Instructions for payment: When you click the Payment Processing button you will be taken to the National Numismatic Authority store. There, you will add the total number of standard submissions to your cart. First one @ $19.99 ALL additional coins are $19.99 calculated at checkout. Add the appropriate number of “shipping packages” 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

GRAND OPENING SPECIAL 50% OFF SUBMISSIONS Applied at checkout

Read more: Print additional forms if needed. Maximum value per submission is $5000. (unlimited coins) For Values of $5001-$10,000 (unlimited coins) MUST Add an additional “SHIPPING PACKAGE” to the cart. All submissions MUST include at least 1 “SHIPPING PACKAGE” 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