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PLEASE FILL OUT THIS FORM AND MAIL TO:

11400 W. Olympic Blvd Suite 800

Los Angeles, CA 90064

Attn: Bid Department

FAX TO:

310-551-2626

Bidders who do not have established credit with Ira & Larry Goldberg Coins & Collectibles, Inc. or other leading coin dealers must

enclose a 25% deposit on bids, or bids will not be executed. See our Terms & Conditions for acceptable methods of paymentand before

placing any bids. To expedite verification, please provide the full name and zip code of each numismatic reference.

I HAVE ESTABLISHED CREDIT WITH

IRA & LARRY GOLDBERG COINS

& COLLECTIBLES, INC. OR PROVIDED

NUMISMATIC REFERENCES

NUMISMATIC REFERENCES

1.

2.

3.

SIGNATURE

I HAVE ENCLOSED A DEPOSIT IN

THE FORM OF A (CIRCLE ONE):

BIDDER INFORMATION

By signing above, you permit Ira & Larry Goldberg Coins & Collectibles, Inc. to execute your bid (s) AND agree to the

Terms and Conditions of sale.

First Name (please print or type)

Company Name (if applicable)

Street Address (check if new address)

City

State

Zip Code

Telephone Home (Required)

Daytime

Mobile

Last Name

Middle Initial

Fax

Email

Please send my invoice via:

Fax

Email

Mail

Today’s Date

Resale ID #

Customer #

Money Order

Check

Reference No.

Total Amount $

Name (please print or type)

Business

Daytime Phone

Zip Code

Name (please print or type)

Business

Daytime Phone

Zip Code

Name (please print or type)

Business

Daytime Phone

Zip Code

DATE

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PRE-LONG BEACH AUCTION

February 13, 2017 • Los Angeles, CA

Buyer’s Fee

17.5%