test test NORTH AMERICAN COIN GRADING SERVICE
SUBMISSION FORM

MAIL YOUR AMERICAN OR CANADIAN COINS INSURED TO:
Jerry's P. S., Inc., P. O. Box 554, Bridgeport, Michigan 48722-0554
Minimum submission to NACGS is 5 coins please! Print out this form to submit.
IMPORTANT! CHECK 1 ONLY:
I want white inserts (looks best on coins)
I want green inserts
Quantity
Date/Mint
Denomination
Variety
Grade Expected
Insured Value
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________
<# of Coins

Total Value>
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FEE CALCULATION
______ coins x $15.00 per coin = $__________
(If your total value is $2000 or less.)
Includes return postage and Insurance.
Please add 1% of total value over $2000 for added insurance. Sample: A total value of $5000 would cost $15 per coin + 1% of $3000 (value over $2000) for an additional cost of $30.00.
$___________ over $2000 x .01 = $__________
Total enclosed: $_________________
(Includes postage, packaging and insurance)
(send check or money order with submission)
Please allow approximately 21 days for return.
SUBMITTER INFORMATION
NAME: _____________________________________
ADDRESS: __________________________________
CITY: ______________________________________
STATE, ZIP: _________________________________
PHONE: ____________________________________
EMAIL: _____________________________________

Copyright 1999-2009 - Jerry's P. S., Inc., P. O. Box 554, Bridgeport, MI 48722-0554
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