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IN.gov

Registration Form

Registration for Sellers of Foreign Precious Metal Bullion and Currency

Seller Information

Your Name:

Email:

Verify Email:

Business Name (or Individual if Sole Proprietor):

Trade Name or DBA (if differs from Business Name):

Phone:

Alt Phone (evenings and weekends):

Business Type:

Physical Address

Address Line 1:

Address Line 2:

City:

State:

Zip:

Physical same Mailing?

Mailing Address

(if differs from Physical)

Address Line 1:

Address Line 2:

City:

State:

Zip:

Coin Show or Trade Fair Information

Name of Show:

Organizer:

Contact:

Phone:

Start Date:

End Date:

Location/Venue of Show

Address Line 1:

Address Line 2:

City:

State:

Zip: