CPA SUBMISSION FORM
NAME___________________________________________________________
PHONE NUMBER____________________________________________________
EMAIL__________________________________________________________
STREET ADDRESS__________________________________________________
CITY _____________________STATE_______________ZIP CODE___________________________
BOOK PAGES TO BE REMOVED FROM BOOK AND GRADED
BOOK 1
COMIC AND ISSUE NUMBER _____________________________________
STORY NAME AND PAGE NUMBERS TO BE GRADED _____________________________________________________
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TOTAL PAGES TO BE GRADED THIS BOOK______________________
BOOK 2
COMIC AND ISSUE NUMBER ___________________________________________________
STORY NAME AND PAGE NUMBERS TO BE GRADED______________________________________________________
______________________________________________________
______________________________________________________
TOTAL PAGES TO BE GRADED THIS BOOK______________________
BOOK 3
COMIC AND ISSUE NUMBER ______________________________________________________
STORY NAME AND PAGE NUMBERS TO BE GRADED______________________________________________________
______________________________________________________
_______________________________________________________
TOTAL PAGES TO BE GRADED THIS BOOK_______________________
BOOK 4
COMIC AND ISSUE NUMBER ______________________________________________________
STORY NAME AND PAGE NUMBERS TO BE GRADED______________________________________________________
______________________________________________________
______________________________________________________
TOTAL PAGES TO BE GRADED THIS BOOK_______________________
BOOK 5
COMIC AND ISSUE NUMBER ______________________________________________________
STORY NAME AND PAGE NUMBERS TO BE GRADED______________________________________________________
______________________________________________________
______________________________________________________
TOTAL PAGES TO BE GRADED THIS BOOK________________________
TOTAL FEES
TOTAL NUMBER OF PAGES TO BE GRADED_________X $16.00 =$________GRADING FEES ( MINIMUM ORDER IS 50 PAGES ]
TOTAL NUMBER OF PAGES TO BE GRADED_________X $1.28 =$________SHIPPING COST
SHIPPING INSURANCE. NUMBER OF PAGES _______X.99 =$ _______ INSURANCE (INSURANCE FOR ORDER UP TO $4999.99)
***FOR INSURED AMOUNT ABOVE $5000 CONTACT US FOR A QUOTE
TOTAL DUE WITH ORDER SUBMISSION =$________
EXECUTION OF AGREEMENT
I acknowledge and agree that by submitting collectibles to CPA I waive any right to assert any form of legal claim against CPA or any of its respective employees, officers, directors or agents. CPA disclaims any and all warranties, expressed or implied regarding CPA's holder
and / or its services. Including but not limited to warranties of merchantability and fitness for a particular purpose. In no event shall CPA
or any of its respective employees, officers, directors or agents be liable to customer or any other party for any indirect, incidental, or special,
consequential or exemplary damages.
Customer signature___________________________________ Print name______________________________Date____________
Instructions
Print and complete this form and mail with pages to be graded to:
COMIC PAGE AUTHENTICATION LLC
P. O. BOX 394
MOORESVILLE, NC 28115
DON'T FORGET TO SIGN THE EXECUTION OF AGREEMENT AS WE CAN NOT PROCESS YOUR ORDER WITHOUT YOUR SIGNATURE.