CGA
THE ORIGINAL AND FIRST GRADING SERVICE

CGA, INC. SUBMISSION FORM

CUSTOMER NAME_______________________________________

Ship To: Name:____________________________ Address:__________________________ City:_____________________________ State:_______ Zip:______ Phone:__________________

Shipping Method: o INSURED MAIL o REGISTERED MAIL

Submission Type (per note): o Express - $50.00 5 working days or less o Regular - $30.00 (Note valued $300 or more) 10 working days or less o Economy - $20.00 (Note valued under $300) 15 working days or less

CGA ONLY Date Received:___________ Date Sent:_______________ Amount Received: $_____________

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I HAVE READ THE TERMS AND CONDITIONS OF THIS FORM. I UNDERSTAND AND AGREE TO ALL THE TERMS AND CONDITIONS. _____________________________ Signature Date

CGA INC. PO Box 418 Three Bridges, NJ 08887 Phone(908)788-8866 Fax:(908)788-1677 info@cganotes.com http://www.cganotes.com

Total Value:_______________________________ ____ NOTES x ______ FEE = __________ SHIPING AND INSURANCE = ________  TOTAL =__________

**SUBMISSION FORMS CAN BE COPIED**

PAGE 02-CGA SUBMISSION FORM

Shipping & Insurance Rates

Declared Value	Total Shipping and Insurance Rate
$0.00 to $5,000.00	$15.00
$5,000.01 to $10,000.00	$20.00
$10,000.01 to $25,000.00	$25.00

Grading Terms And Procedures CGA warrants to use due diligence in grading currency.   However it makes no other warranties either expressed or implied.   All parties recognize that the grading of currency involves professional judgment by experts and the grade assigned to currency may  vary from expert to expert. CGA shall not be liable for any discrepancy or negligence in its handling of currency unless notice in writing is given to CGA within five(5) days of receipt of same by the owner via certified mail return receipt requested. CGA shall not be liable for any damage to currency resulting from taking said currency out of CGA holder or any other mishandling that has occurred while the currency was in our care. CGA shall be entitled to its fee for grading the currency notwithstanding the fact the currency fails to meet the minimum grade set by owner or due to the not grading by CGA standards. CGA shall not be liable for any clerical error in the description or grading of currency; its sole liability shall be limited to correcting  currency the clerical error. CGA will try to grade currency within the time frame allotted for the service.  If for any reason CGA is unable to grade said currency in that time, CGA shall have no liability, except for express services which may at our discretion be discounted to regular service rates. CGA reserves the right to amend, alter and change its terms and conditions without prior notice. The terms of this agreement shall be governed by the laws of the State Of New Jersey without regard to principles of conflict of laws.  Any dispute shall be submitted to arbitration under the rules of  The American Arbitration Association.  The venue for any dispute shall be in the State Of New Jersey.   All parties her to waive trial by jury.

REMEMBER: Fill in dealer name Fill in "Ship To" information Fill in shipping method Check submission type Fill in all descriptive information along with minimum grade (if any) and value Add up all costs.  Service, shipping and insurance Place each note in its own separate holder Full payment must be sent with order.  Call for fees. Make checks payable to CGA, Inc. ALWAYS RETAIN COPIES FOR PERSONAL RECORDS

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