ORDER FORM

Prototype Coins, Medals, & Tokens by Moonlight Mint and Daniel Carr

These items can be ordered by visiting www.dc-coin.com , or by mailing this order form to the address shown below.

Please see other catalog pages for catalog numbers, item descriptions, and prices.

Write catalog number, brief description, price, quantity, and total on each line below.

Note: Items with prices listed as “Sold Out” or “N/A” are not available.

Catalog #

Description  

Each

Quan

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Product Total:

$

 

Flat-rate insured shipping $10 USA ($20 international) per order, regardless of the number of coins

$

 

 

 

 

Grand Total With Shipping:

$

 

Prices and availability are subject to change without notice.

Paypal orders accepted at:   www.dc-coin.com .
Paypal payments can also be sent directly to:   dcarr@DesignsComputed.com

Please send order form, along with credit card info, check, or money order, payable to:

Designs Computed

P.O. Box 7486

Loveland, CO

80537-0486            USA

970-667-7610

info@DesignsComputed.com

www.DesignsComputed.com
www.dc-coin.com

 

Credit card orders (shipping address must be the same as billing address)

Card Type

___ Visa

___ Master Card

___ Discover

Card Number



___  ___  ___  ___

 

Expiration Date



___  /  ___

Signature (for credit card orders only)



__________________________

 

Shipping

* Optional Fields -----------------------------------------------------------

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* TELEPHONE

 

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