Dahlonega Gold Mint Print

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Order Form For Dahlonega Mint Print

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.
QUAN ITEM DESCRIPTION PRICE SHIPPING TOTAL
Limited First Edition Print (500) $125.00 $6.75
Limited First Edition Print W/Frame $225.00 $10.00
Limited First Edition Print W/Frame & Dahlonega Gold Coin POR


Sales Tax Ga. residents 7%


Total check, money order, credit card

Name:

Company:

E-mail:

Day Phone:

Night Phone:

Shipping Address:
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



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