Company or Unit Name:

Second E-mail Address:

Office Phone:

(must be 10 digits)

After Hours Phone:

(must be 10 digits)

Shipping Address same as Billing 

Billing Address:

Shipping Address:

Date Coins needed:
(example: 10 Apr 05)
(Must be a date- no ASAP)

Coin Size:
Select Size 1 5/8" 1 3/4" 2" 2 1/2" Dog Tag

Metal Color:
Select Color Antique Gold Antique Silver Bright Shiny Gold Bright shiny Silver .999 silver Shiny Black silver Antique Bronze

Color Fill on Coin:
Select Color Color Fill 1 side Color Fill 2 sides No Color Fill
(No limit on colors)

Coin thickness:
Select Thickness 3mm 2mm 4mm $.10 more a coin
(Normal thickness 3mm)

Diamond Wave Cut:
yes No

Diamond Swirl Cut:
yes No

Epoxy Over:
Select Cover one side epoxy cover two sides epoxy cover none

Special cut outs on coin :
yes No

Picture Insert on coin :
yes No

Ribbed Edge on coin:
yes No

Make Key Chain from coin:
yes No

Odd Shape:
yes No

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