ANA APPLICATION FOR MEMBERSHIP IN …

                   ANA APPLICATION FOR MEMBERSHIP IN
             PAPER MONEY GUARANTY, LLC SUBMISSION NETWORK

Please print clearly. When completed, please sign and date in the space provided and return to:

PMG - P.O. Box 4755, Sarasota, FL 34230

ASSOCIATE MEMBER INFORMATION                                   SHIP TO INFO (IF NOT THE SAME)
Name: _________________________________________                Name: ________________________________________
Address: _______________________________________               Address: ______________________________________
City: _____________________State: _____ Zip: ______            City: ____________________State: ______ Zip: _____
Phone: _____-_____-_____ Fax: _____-_____-_____                Phone: _____-_____-_____ Fax: _____-_____-_____
E-mail: _________________________________________              E-mail: _______________________________________

ANA Membership #: ________________________________________________________

NGC Submitter # (if applicable): _____________________________________________


PAYMENT INFORMATION
Credit Card Type (check one) MasterCard ______ Visa______ American Express______
Credit Card Account #: __________________________________ Expiration: _____/_____
Name & Billing Address for Credit Card (if different than above):
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

CREDIT CARD APPROVAL AND RELEASE:
I authorize PMG or its member grading services to charge the card account listed for grading services
performed. I acknowledge that by completing and signing this application, I agree to pay fees incurred in
the full amount through my credit card account. If I submit notes 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 PMG Membership with no
entitlement to a refund. With prior notice to me by e-mail, fax, or phone, 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 PMG, 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 fifteen (15) business days notice.

Printed Name: _____________________________________________________________________________________________

Signature:___________________________________________________________________________ Date:_________________
ASSOCIATE MEMBER AGREEMENT
1. The undersigned Associate Member of Paper Money Guaranty, LLC (PMG) agrees to be bound by and
   comply with the procedures and rules governing submission of notes for grading, as shall be prescribed
   by PMG from time to time. The undersigned acknowledges that the right to submit notes as an Associate
   Member extends only to notes owned by the undersigned, and that submission by the undersigned of notes
   owned by third parties will void this agreement. Membership shall continue until terminated by either party
   upon thirty (30) days written notice to the other party unless earlier terminated for any reason stated below.

2. An Associate Membership shall further be subject to revocation upon fifteen (15) days written notice if an
   Associate Member shall fail or refuse to make timely and proper payment of its financial obligations to
   PMG after requests by PMG to cure and correct such default.

3. The undersigned Associate Member acknowledges membership shall be subject to immediate termination
   upon written notice from PMG if a member shall be the subject of a judicial or quasi-judicial proceeding
   in which a final judgment, order, or finding shall be issued by a court tribunal of competent jurisdiction
   concluding an Associate Member is responsible for conduct (acts or omissions) which constitute (i) fraud
   or deceit, (ii) an illegal conversion of client or fellow note dealer'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 PMG and/or the numismatic industry. In addition, PMG reserves the right in its sole discretion
   to terminate PMG Membership at any time on written notice should the member engage in behavior that
   PMG considers abusive or inappropriate with respect to the staff of PMG or any affiliated grading or
   conservation service, or with respect to any other member of the submitting community.

4. This Agreement will be governed and construed in accordance with the laws of the State of Florida as
   applied to transactions taking place wholly within Florida between Florida residents. The undersigned
   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 Agreement.

5. The undersigned does ____, does not ____(check one) consent to the use of its name by PMG in periodic
   advertising in print and other advertising media.

Printed Name: _____________________________________________________________________________________________

Signature:___________________________________________________________________________ Date:_________________