| 2000 World Coin Sets - Order Form - USA |
| Quantity | Description | Date | Price per Set | Total $ . ¢ |
| Postage & Packing Airmail | $10.00 | |||
| Postage & Packing Fully Insured | $20.00 | |||
| Check enclosed payable to "Chard" | Total $ | |||
| Name |
| Street Address |
| City |
| State |
| Country - USA / Other |
| Zipcode |
| E-mail address for advice of despatch |
| Please mail your cheque to: Chard, 521 Lytham Road, Blackpool, Lancashire, FY4 1RJ, England |