Order Form
For mail orders, print out this page and record the items you wish to order. We accept payments by VISA, MasterCard, AmericanExpress as well as personal check or money order (made out to Jencius Coins). Orders are shipped via First Class or Priority Mail. Shipping rates.
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Date: Name: Address:
Phone:
Email*: |
_______________________ _______________________ _______________________ _______________________ _______________________ (in case there's any problem with your order) _______________________ |
Jencius Coins P.O. Box 280041 Brooklyn, NY 11228 Tel: 718-836-0674 |
Order Items
| QUANT | DESCRIPTION | UNIT | TOTAL |
|---|---|---|---|
| 1) | |||
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| N.Y. Tax | |||
| Postage | |||
| TOTAL | |||
Check/Money Order Enclosed # __________ TOTAL AMOUNT __________
VISA/MasterCard/AmEx# __/__/__/__/__/__/__/__/__/__/__/__/__/__/__/__
Security Code (CV2) Number: __/__/__/
Expiration Date ___________ Signature ____________________________
* E-mail address is used to notify the customer of shipping date and is not required. The e-mail addresses of our customers are not disseminated or otherwise used for marketing purposes without our customers’ active permission.
