INSTRUCTIONS FOR COMPLETING THIS APPLICATION:
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Fill in all applicable information requests.
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Answer each question completely.
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Read the Terms and Conditions.
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Sign and date in the space provided when finished.
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Return this form to:
Collectors Society P.O. Box 4711 · Sarasota, FL 34230 or FAX TO : 941-360-2553
CORRESPONDENCE INFORMATION
Title qMr. qMs. qMrs. qDr. First Name
Last Name
Address
Apartment, Suite, Floor
City
State/Province
Zip/Postal Code
Country
Day Phone
Daytime Fax
Evening Phone
Birthday Gender
SOCIETY ACCESS INFORMATION
Your e-mail address
(for user name. Max. 45 characters)
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Mother's maiden name:
Public Name:
Please send me coupons for (check only one)
q NGC & NCS q PMG q CGC qSGC
PAYMENT INFORMATION
I understand that the yearly membership fee for the Collectors Society is US$99. I understand that this fee is refundable for the first 30 days or until the first free grading coupon is
redeemed, whichever comes first. I wish to pay by:
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Check enclosed (to "Certified Collectibles Group")
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MasterCard
q
Visa
q
American Express
Credit Card Account #
Expiration Date
Name & Billing Address for Credit Card
(if different than Society Member above):
CREDIT CARD APPROVAL AND RELEASE
Must be completed and signed in order to pay the Collectors Society by credit card.
I authorize the Collectors Society or its member grading services to charge the card account listed below upon receipt of my order for one year of membership in the Collectors Society, or upon receipt of my request for grading services from the Society's participating
grading services. I acknowledge that by completing and signing this application I agree to pay Collectors Society the full amount of the membership fee through my credit card account. If I submit coins, cards, or comics through the Society submission forms and select
payment by credit card, I agree to pay the member grading service to which I made the submission the full amount of the requested grading fees, service charges, and shipping expenses on a card number I supply regardless of the final grading opinion provided. I
ALSO AGREE THAT IF A DISPUTE ARISES IN REGARD TO THE GRADING SERVICE MY REMEDY IS TO GIVE WRITTEN NOTICE ACCORDING TO THE INDIVIDUAL GRADING SERVICES' POLICIES AND GUARANTEE WITHIN 14 DAYS OF RECEIPT OF SAID GRADED ITEMS.
I understand that if I disregard this provision, I shall be subject to immediate discharge from CCS Membership with no entitlement to a refund, as well as an immediate loss of any unused grading coupons. With prior notice to me by eMail, fax or phone call, the
individual grading services reserve the right to post additional charges to my account if extra or different services are required. I hereby agree to the Certified Collectibles Group, or the individual participating grading services from whom I request services, to bill the
credit card I provide unless otherwise notified by me in writing and with 15 business days notice.
MEMbER TERMS AND CONDITIONS
Terms and Conditions of Membership 1. Upon acceptance by the Collector's Society ("CCS") of the applicant as a Member, the Member agrees to be bound by and comply with CCS's procedures and
rules as the same may be prescribed by CCS from time to time. 2. The Member hereby authorizes CCS or its member grading services to charge the card account listed below upon receipt of the Member's order for one year of membership in CCS, and upon receipt of
requests from the Member for services from CCS's participating grading and conservation companies. The Member acknowledges that by completing and signing this application and agreement the Member agrees to pay CCS the full amount of the membership fee through
the credit card account listed in the application, and agrees to pay for any membership renewals requested by the Member and approved by CCS. If the Member submits coins, paper currency, cards, comics or other collectibles through CCS submission forms and selects
payment by credit card, the Member agrees to pay the applicable grading or conservation service to which the Member made the submission the full amount of the requested grading or conservation fees, service charges, and shipping expenses on such credit card (or such
other card as may be provided subsequently) regardless of the final grading opinion provided or conservation service provided. THE MEMBER ALSO AGREES THAT IF A DISPUTE ARISES IN REGARD TO THE GRADING OR CONSERVATION SERVICE, THE MEMBER'S REMEDY IS
TO GIVE WRITTEN NOTICE ACCORDING TO THE INDIVIDUAL GRADING OR CONSERVATION SERVICES' POLICIES AND GUARANTEE (IF ANY) WITHIN 14 DAYS OF RECEIPT OF SAID GRADED OR CONSERVED ITEMS. The Member understands that if the Member disregards
this provision, the Member shall be subject to immediate discharge from CCS Membership with no entitlement to a refund, as well as an immediate loss of any unused grading or conservation coupons or credits. With prior notice to the Member by email, fax or phone call,
the individual grading and conservation services reserve the right to post additional charges to the Member's account if extra or different services are required. The Member hereby agrees to the Certified Collectibles Group, or the individual participating grading or conserva-
tion services from which the Member requests services, to bill the credit card provided unless otherwise notified by the Member in writing and with 15 business days notice. 3. The Member acknowledges that the CCS membership fee is refundable only in the first 30 days or
until any or all of the free grading or conservation coupons are used, whichever comes first. After 30 days there is no membership fee refund. The Member understands that CCS Membership shall be subject to immediate termination upon written notice from CCS if the
Member is the subject of a judicial or quasi-judicial proceeding in which a final judgment, order, or finding shall be issued by a court or tribunal of competent jurisdiction concluding that the Member is responsible for conduct (acts or omissions) which constitute (i) fraud or
deceit, (ii) an illegal conversion of a fellow Member's property, (iii) a violation of federal or state criminal statutes, or (iv) conduct involving moral turpitude, or otherwise which would threaten the reputation of CCS and/or the collecting community. The Member understands
and agrees that CCS Membership is further subject to revocation upon thirty (30) days written notice if the Member fails or refuses to make timely and proper payment of financial obligations to CCS or its participating grading or conservation services after requests by CCS
or the individual service to cure and correct such fault. In addition, CCS reserves to right in its sole discretion to terminate CCS Membership at any time on written notice should the Member engage in behavior that CCS considers abusive or inappropriate with respect to the
staff of CCS or any affiliated grading or conservation service, or with respect to any other member of the CCS community. 4. The Member understands and agrees that each grading and conservation service is a separate business and is responsible solely for the services it
provides, and not for the services provided by the other grading or conservation services of the Certified Collectibles Group. Society members are not employees of CCS. The Member is financially responsible for coins, paper currency, cards, comics or other collectibles submit-
ted to the participating grading and conservation services or the Certified Coin Registry (including risk of loss during shipment), except when said collectibles are in the grading or conservation services' or the Registry's possession. Payment for all services must accompany each
order. Charge cards are billed on the day of receipt. 5. The Member further agrees that all worldwide rights to use, reproduce and distribute imaged coins, paper currency, cards, comics or other collectibles submitted by the Member in any media, including without limitation,
print, video, Internet, catalogs or other publications, belong to the Member and CCS. Such rights shall extend to any technology now known or which may hereafter become known. The Member agrees that if, as a result of CCS's use of imaged material as set forth herein,
any releases, authorizations, consents, payments and/or licenses are required from any third party, then the Member shall be fully responsible for any such releases, authorizations, consents, payments and/or licenses and further agrees to hold CCS harmless from and against
any losses, costs, claims, judgments, damages and expenses arising from the Member's breach of the foregoing obligations. 6. The Member shall indemnify and hold CCS and its member services, affiliates, and all of its and their respective employees, officers, directors and
agents, harmless from and against all claims, liabilities, and expenses (including reasonable attorney's fees) relating to or arising under this Application Form and Agreement (including these Terms and Conditions) and the transactions contemplated hereunder, except to the
extent finally judicially determined to have resulted primarily from the bad faith or intentional misconduct of CCS. IN NO EVENT SHALL CCS OR ANY ITS MEMBER SERVICES, AFFILIATES, OR ANY OF ITS OR THEIR RESPECTIVE EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS,
BE LIABLE TO THE MEMBER OR ANY OTHER PARTY FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, AND IN NO EVENT SHALL THE AGGREGATE LIABILITY OF CCS, ITS
MEMBER SERVICES, ITS AFFILIATES, AND ANY OF ITS OR THEIR RESPECTIVE EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS, EXCEED THE FEES PAID OR PAYABLE TO CCS AND ITS MEMBER SERVICES BY THE MEMBER. THE MEMBER'S SOLE REMEDY AND CCS'S SOLE
LIABILITY WITH RESPECT TO ANY CCS MEMBER SERVICES SHALL BE PURSUANT TO THE APPLICABLE GUARANTEE, IF ANY, OFFERED BY THE MEMBER SERVICE IN CONNECTION WITH SUCH MEMBER'S SERVICE, AND CCS, ON BEHALF OF ITSELF AND ITS MEMBER SERVICE,
HEREBY DISCLAIMS ALL OTHER WARRANTIES OR GUARANTIES, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. 7. The Member understands and agrees that Dealers
of NGC, PMG, NCS, CGC and any other Certified Collectibles Group company may not also be members of CCS, and that membership in CCS is limited to one per household. 8. This Application Form and Agreement, including these Terms and Conditions, constitutes the
entire agreement between the Member and CCS and may only be amended in a writing signed by both parties. This Application Form and Agreement, including these Terms and Conditions, shall be governed by and construed in accordance with the laws of the State of
Florida as applied to transactions taking place wholly within Florida between Florida residents and shall apply with respect to all submissions of collectible items by the Member through CCS. The Member hereby expressly consents to the exclusive personal and subject-matter
jurisdiction of the state and federal courts located in the County of Sarasota, State of Florida, for any dispute arising from or related to this Application Form and Agreement (including these Terms and Conditions) or any transaction contemplated hereunder. The Member
agrees that CCS may assign or delegate any of its rights and/or obligations to any affiliated grading or conservation service.
ALL INFORMATION IN THIS APPLICATION IS HELD IN THE STRICTEST CONFIDENCE
2007
MEMbERSHIP APPLICATION
COLLECTORS SOCIETY
Collectors Society · P.O. Box 4711 · Sarasota, FL 34230 · 1-800-587-1897 · phone 941-360-3994 · fax 941-360-2553 · www.Collectors-Society.com
www.collectors-society.com
The Collectors Society and its participating grading firms are independent members of
the Certified Collectibles Group, the world's leading group of independent certification & collectibles companies.
Print your name ____________________________________________________________________ Signature ______________________________________________________________ Date ______________________
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This is a confirmation question in the event you forget your password.
This name will be viewed by the public when you have sets in the registry.
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