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PGX Comics
ACCOUNT #:
NEW CUSTOMER:
NAME:
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RESIDENTIAL: BUSINESS:
ADDRESS:
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CC Info Same as Above: EXP DATE: SCC#:

PRE-SCREEN FOR GRADES (If a book does not pass: $5.00 - Total cost will be adjusted when books finish grading)
Screening Info
Golden Age = (Pre-1961)  
 Standard = (1961-1977)  
 Modern = (1978-Current)  
 Express = (10 BUSINESS DAY TURNAROUND)

Qty. Title
Issue #
 Grading Pressing Signature
Re-Case/Pre-Screen
F.M.V* ($)
 Total
TOTAL QUANTITY TOTAL
DISCOUNT
SHIPPING
*FAIR MARKET VALUE - DETERMINES THE AMOUNT OF INSURANCE YOU REQUIRE FOR RETURN SHIPPING INSURANCE*
Notes/Requests TOTAL AMOUNT
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