Note: Please print this form before or after filling it out and either fax with your credit card number or mail to us with your check or credit card number. Use all CAPS to fill in on screen.In order to process your order with a credit card, please supply us with the following information:
VISAMasterCardDiscover American Express
Card #: Expiration Date:I AGREE TO PAY THE ABOVE AMOUNT. ALL SALES ARE FINAL.
___________________________________
CARDHOLDER SIGNATURE
Please enter your check or money order number:
* * * Make checks or money orders payable as follows: * * *
Hancock & Harwell Rare Coins
3155 Roswell Road, Suite 310
Atlanta, GA 30305
404.261.6565 Fax 404.237.6500