Personalised Medallions Order Form - perthmint.com

1 Sub Total$$$Shipping ChargeGrand TotalMEDALLION ITEM CODEMEDALLION DESCRIPTIONQTY$ EACHLINE TOTALP ersonalised Medallions Order FormMember NumberDelivery AddressChange of AddressOR NEW Member?(if different from completed on left) Name:Name:Address:Address:Suburb:Suburb: State:State:Postcode:Postcode:Email:Dayt ime Telephone No:Daytime Telephone No:Email:OrCard NumberCardholder NameExpiry DatePAYMENT DETAILSS ecurity CodeThe unique non-embossed number printed on the signature panel on the reverse of your card or, for Amex holders, it is the unique non-embossed number printed on the front of your card above your main credit card enclose my Cheque / Money Order (payable to The Perth Mint ) for the amount of $Charge my (please circle): MasterCard / Visa / American ExpressNB.

2 EXPRESS COURIER must be signed for by a person living at the nominated RATE$ Per DeliveryExpress CourierAUSTRALIA SHIPPINGINTERNATIONAL SHIPPINGNEW , CAN & OF Delivery1 Item4-6 Items2-3 ItemsActual Size (mm)Maximum Diameter Thickness TO Order YOUR Personalised MEDALLION(S)1. Include your choice of Medallion on this Order form with the appropriatecode (see website), quantity and price for your choice of Decide what message you would like on your Medallion up to 7 lines,20 characters Insert your Personalised message in one of the circles below.

3 You canorder up to 3 Medallions on this Order form . Please include anadditional Order form for more than 3 Our skilled medallion engravers will choose the most appropriate sizeand style of font depending upon the length and style of yourpersonalised Personalised Medallions are non-returnable and are not covered by our30-Day Guarantee, unless an engraving error is made by The Perth PACKAGING - Latex Framed Case with Perth Mint Swan Logo$ Corporation (trading as The Perth Mint) does not disclose personal information about any of its customers to any unrelated third party or any unauthorised personnel.

4 Information may only be disclosed to authorised government and legal authorities, and authorised contractors conducting business on our behalf. Generally you have received this information because you have previously purchased from us or you have requested to receive it. Should you no longer wish to receive such information from The Perth Mint, either by mail or e-mail, please contact our Customer Service Centre on Freecall 1800 098 817 or +61 8 9421 TO SHOP FROM THE PERTH MINTTERMS AND CONDITIONSPRIVACY AND SECURITYE mail NewslettersSubscribe to our email newsletter at to receive the latest information on new releases, special offers, competitions and much , Refunds & Exchanges.

5 All items (excluding bullion products) carry our 30-Day Money Back Guarantee, which allows the returned items to be replaced or refunded of the purchase price (excluding delivery charges). Please contact our Customer Service Team before returning any : your Order anytime day or night by visiting our website, or by emailing the address above. Delivery:Orders are normally despatched within 2 days subject to payment and stock availability. Delivery usually takes 1-2 days from despatch. To check on the progress of your Order , contact our Customer Service Team.

6 Please provide a contact email to ensure you receive a notification on your despatched Australia: 1800 098 817 International: +61 8 9421 7218 Credit card orders may be placed by phone between 8:30am and 4:00pm Monday to Friday (AWST). Mail:Send your Order with your payment or credit card details to: The Perth MintReply Paid 6297PO Box 6297 East Perth WA 6892 AUSTRALIAFax Australia: 08 9225 5012 Fax International: +61 8 9225 50121. All prices are in Australian dollars, inclusive of GST where applicable,and are correct at the time of printing.

7 The Perth Mint reserves theright to amend prices without All items are available at the time of publication and, unlessotherwise notified, orders will be accepted on a first-come, first-served basis while stocks Orders will not be processed without payment. Payments notreceived within seven days will result in cancellation of the Order ,without Credit cards will be debited and cheques banked on receipt of In the event of any one or more coins being over-subscribed or notavailable, an appropriate refund will be made and the balance ofthe Order Incorrect payments will be returned for correction before the ordercan be Delivery charges must be included.

8 As indicated on the Order A lay-by service is offered for orders in excess of $300 with paymentsto be made in four (4) equal monthly instalments by credit card,cheque or money Order . The first instalment must be a quarter ofthe total Order value (including shipping) and must accompany theorder. After the final payment is received, the goods will bedispatched to you. When lay-by payments are made by credit card,authority for all four payments is deemed to be given with the firstpayment, and no additional authority will be requested.

9 Lay-bycannot be accepted for bullion coins. Lay-by orders not completedwill incur a $50 administration charge. Only one lay-by at a time isallowed per customer. Once a lay-by has been set up it cannot Subject to Australian Consumer Law, the proprietor of The PerthMint, its servants/agents make no representations or warranties,express or implied, or offer or give any advice or opinion as to thenumismatic or investment value or potential or otherwise of any of6. The number of units issued to any individual in response to an orderthe be the sole decision of The Perth Mint.

10 12. Although every care has been taken in the preparation of thispublication, The Perth Mint and its affiliates cannot be heldresponsible for the accuracy of any statistic, statement orrepresentation made. The Perth Mint and its affiliates cannotaccept any liability for any loss suffered as a result of any actionwhatsoever taken by any person based on this For full Terms & Conditions refer to Toll Priority is used for all domestic orders. Express courier deliveriesmust be signed for by a person living at the nominated , if your delivery address is an unmanned delivery box ( Box, Parcel Lockers, RMB), our Customer Service Team willdispatch your Order via Australian Post as a registered Office: Gold Corporation Trading as The Perth MintABN.