24KTCASH.COM

ITEM LIST AND PAYMENT OPTIONS FORM

Please print, complete and sign this form. Place it in the Gold Pak with your gold items before shipping to us.

First name: ________________________    Last name: _______________________

Address: _____________________________________   Apt/unit #: _____________

City: _____________________________________   State: _____   Zip: ___________

Daytime phone: _____ - _____ - _______   Evening phone: _____ - _____ - _______
Email address:

 ____________________________________________________
 

How do you wish to receive payment?

Please indicate your payment choice below by placing a checkmark in the left column.

Selection:	Payment type:	What we will require along with a copy of your valid ID:
	Company check	Your full name
	Max Cash	You Email address
	Wire transfer	Sales of $2500.00 or more /call for wiring instructions.
Visa  Master  or  Amex	Circle 1	Just your return address for your pre paid credit card !

Please list each item you are selling: (i.e. 1 earring, 1 broken necklace)

Item 1:	Item 6:
Item 2:	Item 7:
Item 3:	Item 8:
Item 4:	Item 9:
Item 5:	Item 10:

I, the undersigned, hereby state that I am currently a resident of the United States and at least 18 years of age. I am the owner of the item (s) that I am selling, and fully authorized to sell said property. I understand the terms and conditions of this sale.

Signature of seller: ___________________________   Date: ___________

Please insert this form, along with a copy of a valid ID, into package before sealing it.

Mail package back to us