Fill out the top portion of this form then print the form, fill in the details about your coins,  mail it to SEGS! Need assistance? Call Toll Free: 1-888-768-7261 Mon-Fri, 9:00am-4:00pm EASTERN 

    Use this form for U.S. COINS ONLY  
    Name:
    Mailing
    address    :
    City    State:      Zip:
    Phone:      Fax:
    Email
    Address

    Instructions/
    Questions/
    Comments    :
    		  
    Item # Date and
    Mintmark    		 Denomination Error Or Variety
    Value    		 Owner's Declared
    Value
    01 _______________ _________________ ___________ __________
    02 _______________ _________________ ___________ __________
    03 _______________ _________________ ___________ __________
    04 _______________ _________________ ___________ __________
    05 _______________ _________________ ___________ __________
    06 _______________ _________________ ___________ __________
    07 ________________ _________________ ___________ __________
    08 ________________ _________________ ___________ __________
    09 ________________ _________________ ___________ __________
    10 ________________ _________________ ___________ __________
    11 _______________ _________________ ___________ __________
    12 ________________ _________________ ___________ __________
    13 ________________ _________________ ___________ __________
    14 ________________ _________________ ___________ __________
    15 ________________ _________________ ___________ __________
      AMOUNT ENCLOSED @ $15.00 PER COIN=  
      Return Shipping Weight $5.70 1-6 coins (add .95 cents per additional coin) 

    If sending three or fewer coins you must send $5.00 for return postage.

    		  
      INSURANCE: "OWNER'S DECLARED VALUE"=

                    See Table Below

    		  
      Tennessee residents add 9.25% Sales tax=  
      TOTAL AMOUNT ENCLOSED=  
      CREDIT CARD # _____________________________EXP. DATE__________  
      CREDIT CARD TYPE (Visa, MC, Discover, American Express, etc.): ______________

    SIGNATURE___________________________________

    		  
    U.S. Postal Service Insurance Rates  Do Not Under-Insure
    $0.00 to $100.00-----------$11.50 $6000.01 to $7000-------$22.55
    $100.00 to $500.00--------$13.10 $7000.01 to $8000-------$23.90
    $500.01 to $1000.00-------$14.45 $8000.01 to $9000-------$25.25
    $1000.01 to $2000.00-----$15.80 $9000.01 to $10,000-----$26.60
    $2000.01 to $3000.00-----$17.15 $10,000.01 to $15,000---$32.00
    $3000.01 to $4000.00-----$18.50 $15,000.01 to $20,000---$38.00
    $4000.01 to $5000.00----$19.85 $20,000.01 to $22,000---$42.00
    $5000.01 to $6000.00----$21.20

    $22,000.01 to $25,000---$46.00

    S.E.G.S.

    P. O. Box 8129 - Eastgate Center
    Chattanooga, TN 37411

    Please enclose Check or Money Order made payable to S.E.G.S. Ship all items by "REGISTERED/ INSURED MAIL" for the total of declared value, and the cost of services listed. Then send your package to the address above.
     

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