coinable.com - precious metal order form
Print this form , complete all information, and fax to 623-266-7318 or print and mail to: coinable.com - 20783 N 83rd Ave, Suite 103-484, Peoria, AZ 85382


Mininmum orders are as follows:   .999 Fine Silver - 25 pieces,   .999 Fine Gold - 25 pieces,   Brass - 100 pieces,   Nickel Silver - 100 pieces
All order must be paid in full upon receipt of the order form to lock in the spot price of the metal
 
Quantity
39mm (1.54")
.999 FINE Silver
 
PROOF
 
PROOF-LIKE
 
BUSINESS STRIKE
 
SATIN
 
BULLION STRIKE

Quantity
39mm (1.54") 24K Gold
 
PROOF
 
PROOF-LIKE
 
BUSINESS STRIKE

Quantity
39mm (1.54") BRASS
 
PROOF
 
PROOF-LIKE
 
BUSINESS STRIKE
 
SATIN
 
BRASS GOLD-LIKE

Quantity
39mm (1.54") Nickel Silver
 
PROOF-LIKE


Features: (Please circle or check those that apply for your coin.)

   CUTOUTS: ____ (How many?)         SPOT PLATING
 
   NUMBERING
____   LASER ENGRAVING - # of characters ____ (EDGE of coin, or FACE)              
 
    Edging:   REEDED EDGE          ROPE EDGE

    Presentation:   # ____ LEATHERETTE BOX (Black only)        # ____ VELVETEEN BOX (Black only)


Customer ID________________________________ (assigned by coinable.com)      We accept :AMEX / VISA/ Master Card/ IMPAC

____ New Order   ____ Reorder           Amount Being Charged:$______________       Promo Code:_______________________________

Credit card#: b
Exp Date: b


Name on card: ___________________________________________________          Notes:___________________________________________________ 

Billing address: __________________________________________________          ___________________________________________________ 

                                      __________________________________________________          ___________________________________________________
 

                                      __________________________________________________          ___________________________________________________
 

Shipping Address: (POC) __________________________________________________          BLIND ____

                                                                (Same?___) __________________________________________________

                                                                 __________________________________________________

Telephone Number: (day)_____________________________ ( ____ evening or ____ cell)_____________________________

e-mail address for receipt of payment:, only one email per line          e-mail address for artwork approval: (Same?____)

_________________________________________________________
         _________________________________________________________

By signing this order form, you certify that you are authorized to sign the debit or credit card listed above, that you have read and agree with the terms of service as listed on our web page at http://www.coinable.com/tos.html, that you agree to have the above credit or debit card charged for the merchandise placed by this order, and if applicable, all artwork, cancellation and die fees as explained more fully in the terms of service.


Signature:_________________________________ Printed name:_________________________________ Date:___________________

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