ORDER FORM

INSTRUCTIONS:

1. Print this form on your computer’s printer.

  1. Fill the form out according to the coins you wish to purchase and your choice of method of payment.
  2. Mail the form, ALONG WITH YOUR PAYMENT, to:

FRIENDS OF THE SEGOVIA MINT

Apartado 315

E-40080, Segovia, SPAIN

500 PESETAS COIN (SILVER) (2 reals)
Number of coins _____ X 2,320 pesetas (13.94 euros) each coin = ______
2,000 PESETAS COIN (SILVER) (8 reals)
Number of coins _____ X 6,960 pesetas (41.83 euros) each coin = ______
10,000 PESETAS COIN (SILVER) (50 reals, cincuentin)
Number of coins _____ X 23,200 pesetas (139.43 euros) each coin = ______
80,000 PESETAS COIN (GOLD) (8 escudos)
Number of coins _____ X 132,240 pesetas (794.78 euros) each coin = ______
COLLECTION OF THE 3 DIFFERENT SILVER COINS
Number of sets _____ X 32,480 pesetas (195.21 euros) each set = ______
COMPLETE COLLECTION OF ALL 4 COINS (3 silver, and 1 gold coin)
Number of sets _____ X 164,720 pesetas (989.99 euros) each set = ______

Total price of coins ______ (in pesetas or euros)

The IVA tax is included in the price of all coins. All individual coins and sets of coins come in a handsome wooden case.

+ POSTAGE AND INSURANCE FEES (mark the box which applies):
 Addresses in SPAIN _____- 0 -_
 Addresses in OTHER COUNTRIES (minimum, no gold) 4,300 ptas. (25.84 euros)_
 Addresses in OTHER COUNTRIES (minimum, with gold) 8,400 ptas. (50.49 euros)_
 Addresses in OTHER COUNTRIES (multiple coins or sets) _____PLEASE INQUIRE_

GRAND TOTAL (coins + postage & insurance) ______(in pesetas or euros)

PAYMENT METHODS (choose one):

I attach a bank draft or postal draft, in pesetas or euros, made out to NUMISMÁTICA DOBLÓN for the GRAND TOTAL indicated above.

I attach a personal check, in any currency, made out to NUMISMÁTICA DOBLÓN for the equivalent value in pesetas or euros for the GRAND TOTAL indicated above + (1,500 pesetas or 9 euros) for bank fees for currency exchange and check cashing = NEW TOTAL______.

Charge the order to my VISAaccount.

Name as it appears on your VISA card______

Account / card number______

Expiration date on card_____ /_____

Signature______

Note: NUMISMÁTICADOBLÓN coin store (calle Domingo de Soto, 1; 40001, Segovia, Spain, Tel.: (+34) 921 – 46 29 91) is the Official Distributor of these coins for the Friends of the Segovia Mint Association. The Association only acts as an agent for the promotion of the coins and the reception of orders through our web site. NUMISMÁTICADOBLÓN will not send the coins until the bank has actually cleared funds.

SEND COINS TO THIS ADDRESS:
Name______
Street and number______
City______State / Province______
Zip code______Country______
Telephone______
E-mail______@ ______
SEND THIS ORDER FORM TO:

FRIENDS OF THE SEGOVIA MINT ASSOCIATION

Apartado 315
40080, Segovia, SPAIN
If you have any doubts or questions, please do not hesitate to contact the Association:
Tel.: (+34) 921 42 09 21

ALL PROCEEDS FROM THE SALE OF THESE COINS

HAVE BEEN DESIGNATED BY THE GOVERNMENT OF SPAIN

TO BE DEPOSITED IN A SPECIAL ACCOUNT OF THE

FUNDACIÓN REAL INGENIO DE LA MONEDA DE SEGOVIA

TO FINANCE CULTURAL PROJECTS AIMED AT RECOVERING THE HISTORIC IDENTITY

AND PROMOTING KNOWLEDGE ABOUT THE SEGOVIA MINT.

We sincerely appreciate your support!