Fillable CERTIFICATE OF NON-RECEIPT (Department of the Treasury - U.S. Mint)

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CERTIFICATE OF NON-RECEIPT (Department of the Treasury - U.S. Mint)

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BROWSE DEPARTMENT OF THE TREASURY - U.S. MINT (DC) FORMS

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False official statement or claims are a violation of Federal Statute and are subject to prosecution.
Revised 6/18
CERTIFICATE OF NON-RECEIPT
Instructions: Please complete and return this form within 30 calendar days after the order shipment date if
your United States Mint order did not arrive, or arrived with missing products. We are unable to process
completed CNRs received more than 90 calendar days after the order shipment date.
Order #: ___________________________
Customer Name: _________________________________________________________________________
Customer Address: _______________________________________________________________________
Telephone (Day) ___________________ (Evening) __________________ (Mobile) ____________________
Description of Missing Item(s):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Quantity Ordered ________ Quantity Received________ Quantity Missing ________
Check the statement which best describes your complaint:
______ Order was not received at all ______ Package arrived without coins
______ Package arrived with 1 or more coins missing ______ Disregard claim (package arrived)
Did your package arrive damaged? Please explain the condition.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Have there been any recent changes to your account information? Please explain.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Comments:
______________________________________________________________________________________
______________________________________________________________________________________
Signature: __________________________________________________ Date: ______________________
Please allow approximately 4-6 weeks for review and processing. Please mail this form to the following address
or fax it to the number below.
UNITED STATES MINT OR Fax Number: 972-421-9801
CUSTOMER SERVICE CENTER
ATTN: CNR E-mail: usmint-support@usmcatalog.com
1201 ELM STREET, STE 3000
DALLAS, TX 75270
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CERTIFICATE OF NON-RECEIPT (Department of the Treasury - U.S. Mint)

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Completed 19 July 2020

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