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First Name

Last Name

Company Name

Street Address

City

State (Required for U.S)

Province

Postal / Zip Code (Required for U.S., Canada, U.K. and Germany)

Country

Primary Telephone

Secondary Telephone (optional)

Important: A valid email address is required to complete registration.

Email Address

Re-enter Email Address

VAT or Tax Number (Dealers only)

Important: Have you made a prior purchase from Harlan J. Berk, Ltd.?

Yes, I have made a prior purchase from Harlan J. Berk, Ltd.

No, I have not made a prior purchase from Harlan J. Berk, Ltd.

Important: If you have NOT made a prior purchase from Harlan J. Berk, Ltd. then two numismatic references are required to complete registration.

Reference 1

Company Name

Telephone

Contact Name

Reference 2

Company Name

Telephone

Contact Name

Important: To bid and sign-in you will need to create a username and password.

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(6 characters minimum and 15 characters maximum)

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