collectorscorner.org store: Printable Coin Supply Order Form: REV.-7/1/20113

PLEASE PRINT ---- _E-Mail Address: _____________@_____________________

NAME:_______________________________________________

ADDRESS:____________________________________________

CITY:____________________________STATE:___________________ZIP:__________________

ITEM NUMBER DESCRIPTION QUANTITY PRICE@
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SUB-TOTAL___________
N.J Residents, please add 7% sales tax on orders ___________
SHIPPING & HANDLING: see below Left ___________
Map & Oak Frame Orders: Weight & Oversized add Extra $2.00___________
OUT of U.S.A. (Canada $20.00) Over Seas ($50.00) + Standard postage above___________
( _ ) Check - - ( _ ) Money Order--or Credit Card: type Visa ( _ ) Master Card ( _ ) Amer. Express ( _ )
cc# __________-__________-__________-__________,
exp date: _______/_______, security code: ________, Signature:________________________________________
U.S Funds Only:.......TOTAL INCLOSED_______________
ON-LINE ORDERS: E-mail us your order and make a Credit Card payment to our pay-pal account, just be sure to add in the postage..

POSTAGE: All map & Oak Frame Orders: Add $2.00 extra
0 to $3.99 add $3.05
$4.00 to $9.99 add $5.15
$10.00 to $16.99 add $6.75
$17.00 to $24.99 add $8.75
$25.00 to $49.99 add $10.75
$50.00 and up add $12.75

E-Mail orders to: biff@diskworks.com

Pay-Pal payment to: webmaster@diskworks.com

Checks / Money Order: payable U.S Funds only:
Disk Works of South Jersey
187 Clayton-Aura Road
Glassboro, New Jersey 08028-3404