Submitter Responsibilities - ANACS

1 Promo Code _____ Page _____ of _____ OFFICE USE ONLY. SUBMISSION form . Box 6000, Englewood, CO 80155. Box # _____ Order # _____. 800-888-1861 Name: _____ Cust #: _____ RETURN SHIPPING. New New Shipping Address: _____ Customer Address Fed Ex Acct. #_____ AM PM. City: _____State: _____ Zip: _____. Phone #1: _____ Phone #2: _____ Exp. Mail Acct. # _____. E-mail: _____ Insurance Limit $ _____. DO NOT SEND MINT PACKAGING * NO STAPLES OR TAPE. PLACE COINS IN 2 X 2 NUMBERED FLIPS & BIND FLIPS WITH A RUBBERBAND. Office Coin Mint Denom- Owner's Coin Crossover Office Quantity Country Variety Imaging Minimum Use Use Only Date Mark ination Value $3 per Only Grade 1.

2 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16 Bill to Address (if different). 17 Name: 18 Address: 19. 20. Total Owner's Value for Entire Order (Required) $ _____ This form expires on December 31, 2018. Office Choose One Tier of Service Payment Calculations Use Max Value Only Mint Coins .. Grading Fee Per Coin X = $_____. 1 $100 $15,000 # of coins Grading Fee per Coin 2 Day .. $49 $10,000. 5 Day (or ATB 5oz) .. $29 $5,000 Required - Please initial one conservation option. 15 $19 $2000 I authorize ANACS to professionally conserve all coins in this invoice at their discretion for a fee of $29* per submission form , up to 20 coins.

3 I have read Economy (5 Coin Min., No Gold) .. $15 $500. and agree to the conservation terms on the reverse of this form . Modern 1950-present (5 Coin Min.) .. $12 N/A. Max Value _____ Yes, Please $29 Flat = $_____. Non Mint Coins Per Coin $49 $10,000 _____ No, Thanks $0 = $_____. Standard or Ancients (pre 1600 ) .. $29 $5,000. Economy (5 Coin Min.) .. $19 $500 X $9 = $_____. # of coins Verification Fee per Coin Modern 1950-present (5 Coin Min.) .. $14 $500. Variety Attribution Verification & Errors - An Additional 15 Day Turnaround Crypto-Themed Physical Tokens ..$29 $100. Other X $12 = $_____. Special Offer ..$ _____ # of coins Research Fee per Coin Reholder.

4 $10 Variety Attribution Research - An Additional 15 Day Turnaround Check# _____ Money Order Other X $3 = $_____. Visa MC Amex Discover # of coins Imaging Fee per Coin Requested Imaging From Above - An Additional 2 Day Turnaround Card Number Exp. Date Return Insurance + Shipping & Handling $_____. I have read the instructions on the reverse and agree to all stated conditions. (see chart on reverse for pricing & limitations on international shipping). I take full responsibility for accurately completing this submission form . ORDERS WILL NOT BE PROCESSED WITHOUT SIGNATURE TOTAL $_____. (Grading + Conservation + Attribution + Imaging + Return Insurance S/H).

5 Signature X _____ Date:_____. CUSTOMER KEEPS LAST GOLD COPY. Promo Code _____ Page _____ of _____ OFFICE USE ONLY. SUBMISSION form . Box 6000, Englewood, CO 80155. Box # _____ Order # _____. 800-888-1861 Name: _____ Cust #: _____ RETURN SHIPPING. New New Shipping Address: _____ Customer Address Fed Ex Acct. #_____ AM PM. City: _____State: _____ Zip: _____. Phone #1: _____ Phone #2: _____ Exp. Mail Acct. # _____. E-mail: _____ Insurance Limit $ _____. DO NOT SEND MINT PACKAGING * NO STAPLES OR TAPE. PLACE COINS IN 2 X 2 NUMBERED FLIPS & BIND FLIPS WITH A RUBBERBAND. Office Coin Mint Denom- Owner's Coin Crossover Office Quantity Country Variety Imaging Minimum Use Use Only Date Mark ination Value $3 per Only Grade 1.

6 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16 Bill to Address (if different). 17 Name: 18 Address: 19. 20. Total Owner's Value for Entire Order (Required) $ _____ This form expires on December 31, 2018. Office Choose One Tier of Service Payment Calculations Use Max Value Only Mint Coins .. Grading Fee Per Coin X = $_____. 1 $100 $15,000 # of coins Grading Fee per Coin 2 Day .. $49 $10,000. 5 Day (or ATB 5oz) .. $29 $5,000 Required - Please initial one conservation option. 15 $19 $2000 I authorize ANACS to professionally conserve all coins in this invoice at their discretion for a fee of $29* per submission form , up to 20 coins.

7 I have read Economy (5 Coin Min., No Gold) .. $15 $500. and agree to the conservation terms on the reverse of this form . Modern 1950-present (5 Coin Min.) .. $12 N/A. Max Value _____ Yes, Please $29 Flat = $_____. Non Mint Coins Per Coin $49 $10,000 _____ No, Thanks $0 = $_____. Standard or Ancients (pre 1600 ) .. $29 $5,000. Economy (5 Coin Min.) .. $19 $500 X $9 = $_____. # of coins Verification Fee per Coin Modern 1950-present (5 Coin Min.) .. $14 $500. Variety Attribution Verification & Errors - An Additional 15 Day Turnaround Crypto-Themed Physical Tokens ..$29 $100. Other X $12 = $_____. Special Offer ..$ _____ # of coins Research Fee per Coin Reholder.

8 $10 Variety Attribution Research - An Additional 15 Day Turnaround Check# _____ Money Order Other X $3 = $_____. Visa MC Amex Discover # of coins Imaging Fee per Coin Requested Imaging From Above - An Additional 2 Day Turnaround Card Number Exp. Date Return Insurance + Shipping & Handling $_____. I have read the instructions on the reverse and agree to all stated conditions. (see chart on reverse for pricing & limitations on international shipping). I take full responsibility for accurately completing this submission form . ORDERS WILL NOT BE PROCESSED WITHOUT SIGNATURE TOTAL $_____. (Grading + Conservation + Attribution + Imaging + Return Insurance S/H).

9 Signature X _____ Date:_____. CUSTOMER KEEPS LAST GOLD COPY. Submitter Responsibilities : Crossover Service Attribution verification and research can slow the turnaround 1) Fill out the submission form completely and legibly. Coins already certified by another third-party grading service time of any tier of service. 2) Sign and date form . must be submitted as crossovers. To do so list the coin as you 3) Include payment with your submission. Submission will not normally would, but also include a minimum crossover grade Variety and Error Attribution be processed with out payment. (this is required) in the Crossover Minimum Grade field.

10 The Variety Attribution Verification & Errors ($9) ANACS will 4) Submit coins in clean, new inch safety flips. minimum grade is your lowest acceptable grade for that coin. If confirm the variety or error of a coin. To use this service list the Do not staple or tape flips the ANACS opinion meets or exceeds your minimum grade, the variety, error, or die pair in the Variety field. The charge for this One coin per flip coin will be removed from the original holder and encapsulated service is $9 per coin. Make sure you account for this fee in the Number flips to corresponding line on submission form in an ANACS holder. If the ANACS opinion is lower than your Payment Calculations area.