Form not valid after 12/31/21
T3 cards must be submitted under Supersized holder size and Express Service Level or higher. Failure to separate Type of Submission, Holder
Size, and Service Levels as noted will result in additional charges and cause significant delays in processing your order.
Autographed cards dated pre-1998 and/or those not directly from the manufacturer must be sent through Card and Autograph Dual Service (fee
may vary depending on card value, see listed restrictions and requirements). Autographed cards dated 1998 and later (direct from manufac-
turer) can be sent through any of the services listed above (note restrictions and requirements for each level). Cards submitted at the Regular
and Economy service level that are 6.25” x 8.25” up to 8.5” x 11” in size will require a Jumbo holder and incur an additional charge of $30.
3. SERVICE LEVEL: (Select one per form)
Select Service Level based on the Declared Value
per item listed. The individual Declared Values
cannot exceed the maximum per Service Level
chosen. You may select a higher Service Level for
a quicker turnaround. Visit PSAcard.com/pricing for
current estimated turnaround.
q
PREMIUM 10
......................$10000
Declared value of $250,000 or higher.
q
PREMIUM 5
........................$5000
Maximum declared value of $249,999.
q
PREMIUM 3
........................$3000
Maximum declared value of $99,999.
q
PREMIUM 2
........................$2000
Maximum declared value of $49,999.
q
PREMIUM 1
........................$1000
Maximum declared value of $24,999.
q
WALK-THROUGH
.....................$600
Maximum declared value of $9,999.
q
SUPER EXPRESS
.....................$300
Maximum declared value of $4,999.
q
EXPRESS
...........................$150
Maximum declared value of $2,499.
(all T3s must be submitted at this service level or higher)
q
REGULAR
...........................$100
Maximum declared value of $999.
q
ECONOMY (NOT AVAILABLE)
............$50
Maximum declared value of $499.
q
REHOLDER
– Re-encapsulation of PSA-graded
trading card
q
For a declared value of $500,000 or higher. . . . . $500
q
Maximum declared value of $499,999 ...... $250
q
Maximum declared value of $99,999. . . . . . . . .$100
q
Maximum declared value of $19,999 ..........$50
q
Maximum declared value of $19,999.
All T3 & Supersized holders must be submitted at this
service or higher ..........................
$35
q
Reholder for Jumbo holders with
maximum declared value of $4,999 ..........
$30
q
Reholder for Standard & Tallboy holders with
maximum declared value of $4,999 ...........
$10
q
OTHER _____________________________________
1. TYPE OF SUBMISSION
:
q
Grading
q
Review
q
Reholder (Select one per form)
2. HOLDER SIZE: (Select one per form)
q
REGULAR (2
11
/16
x 3
13
/16
and under)
THICK/PATCH
TALLBOY CARDS (3
1
/2 x 5
1
/6)
q
SUPERSIZED (under 4
1
/4
x 10”) & T3
FOR COMPLETE HOLDER SIZE DESCRIPTIONS, VISIT PSACARD.COM
q
COINS/PINS
q
JUMBO (over 6
1
/4
x 8
1
/4
” up to 8
1
/2
” x 11”)
Additional $30 holder charge may apply.
(Holder charge not applicable for Reholder/Custom Encap
)
4. SERVICE LEVEL ........
_________
x
$
__________ =
$
___________
# of items grading price subtotal
JUMBO HOLDER
........
_________
x
$
__________ =
$
___________
# of items jumbo holder subtotal
5. RETURN SHIPPING
(per order) Select One:
q
Domestic Return Shipping (see chart on reverse)
=
$
___________
q
International Return Shipping
(see Int’l. chart on reverse)
=
$
___________
Alternate Return Shipping
(Must provide your own FedEx or USPS Express Mail account and insurance
coverage. If acct info & selections are on file with PSA, please write “On File”.)
q
FedEx/USPS Express Mail
Account
#
___________________________
Declared Value limit per package (Required):
____________________________
Purchase FedEx Insurance?
o
Yes $_______
o
No
Signature Required?
o
Yes
o
No
o
Sat. Delivery
o
Pri-Overnight am
o
Std-Overnight pm
o
2-Day
o
3-Day
o
Ground
q
Pick Up
(by approval only)
6. VOUCHER/CREDIT ON ACCOUNT
. . . . . . . . . . .
$
___________
7. TOTAL CHARGES
......................... =
$
___________
METHOD OF PAYMENT
q
Cash
q
Credit Card
q
LOC
q
CCOF
q
Check/Money Order # _________
Cardholder’s Name
__________________________________________________________________________
Card Number
________________________________________________________________________________
Exp. Date ____________________
Cardholder’s Signature _____________________________________________________________________
30
USD
Customer Name: ����������������������������������������������������
Customer #: ��������������������������������������������������������
PSA USE ONLY
SERVICE ______________________
QTY _____________DV __________
RETURN SHIPPING ADDRESS (print clearly)
o
Check if permanent change of address
NAME_________________________________________________________ PHONE ( _____ ) ________________________
ADDRESS_______________________________________________________ EMAIL ________________________________
CITY, STATE, ZIP ______________________________________________________________________________________
ORDER # ______________BOX _______
ITEM # ___________________________
INV TYPE _________________________
DATE RECEIVED ___________________
CARD SUBMISSION #
Visit PSAcard.com for current information including turnaround times, pricing, etc.
PROFESSIONAL SPORTS AUTHENTICATOR
P.O. Box 6180, Newport Beach, CA 92658
(800) 325-1121
(949) 833-8824
PSAcard.com
q
Residential
q
Business
8468580
click to sign
signature
click to edit
CANADA
1 - 10 items ����������� $46�00
11 - 20 items ����������� $50�00
21 - 30 items ����������� $54�00
31 - 50 items ����������� $59�00
51 - 60 items ����������� $69�00
Over 60 - $1�25 per item
EUROPE
1 - 10 items ����������� $53�00
11 - 20 items ����������� $58�00
21 - 30 items ����������� $60�00
31 - 40 items ����������� $70�00
41 - 60 items ����������� $75�00
Over 60 - $1�25 per item
ALL OTHER
REGIONS/COUNTRIES
1 - 10 items ����������� $55�00
11 - 20 items ����������� $60�00
21 - 30 items ����������� $65�00
31 - 40 items ����������� $70�00
41 - 60 items ����������� $80�00
Over 60 - $1�25 per item
Specific carrier
requests may result
in additional charges�
INTERNATIONAL RETURN SHIPPING
Insurance Included $100,000 Maximum
DOMESTIC RETURN SHIPPING & INSURANCE RATE CHART
TOTAL DECLARED VALUE
Number
of Items
$1 $1,
000
$1,001
$5,000
$5,001
$15,000
$15,001
$25,000
$25,001 –
$50,000
$50,001 –
$75,000
$75,001 –
$100,000
$100,001 –
$150,000
$150,001
$200,000
1 - 8
$14.00 $29.00 $37.00 $44.00 $56.00 $64.00 $79.00 $120.00 $131.00
9 - 25
$20.00 $35.00 $43.00 $47.00 $63.00 $78.00 $93.00 $130.00 $151.00
26+
add .25
per item
add .25
per item
add .25
per item
add .25
per item
add .50
per item
add .50
per item
add .50
per item
add .50
per item
add .50
per item
Declared Value over $200,000 – Add $20 for each $50,000 over.
*Packages over $200,000 will be a two package shipment and could be subject to additional return shipping changes.
SUBMISSION INSTRUCTIONS
1. Print your name, customer number, return shipping address,
email address and phone number in the space provided� For changes
in return shipping address, contact Customer Service before order
completes the grading/authentication process
2. Select the Type of Submission, Holder Size, and Service Level
Only one selection from each category is permitted per submission
form� Please visit PSAcard�com to view current PSA holder sizes� Any
item requiring a Jumbo holder will be subject to an additional $30
holder charge, excluding Reholder Services and custom encapsulation�
GRADING: For raw cards� You may, but are not required to, specify a
minimum acceptable grade� Cards graded below minimum grade will
not be holdered; however, the full grading amount will be charged�
REVIEW: For cards previously graded by PSA that you feel might be
worthy of a higher grade� Submit them in their current PSA holders�
REHOLDER: For any PSA-encapsulated card that you simply wish
to have re-encapsulated using our most current holder/label style�
Please note: All cards will be automatically reholdered UNLESS (1)
the sonic weld on the PSA case shows signs of tampering or (2) the
PSA case is fractured over the card itself� If the case is fractured over/
near the card, it will be examined raw to ensure it has not sustained
damage and that the original grade is still valid�
3. List the description of each item in order from smallest holder size
to largest� For multiple cards of the same type (same year, set, number,
and variety), you may list total quantity and write on one line� On
lines listing more than one item, add together the declared value of all
items listed on the line and enter total on “Declared Value” column�
e Declared Value is your estimate of the value of the item after it
has been authenticated/graded by PSA� We understand you will not
know the true value of the item until it has been graded, so we ask that
you form a realistic, educated estimate based on your own research,
keeping in mind that the Declared Value acts as a maximum value
in the event of a claim related to the item while at PSA, for shipping
insurance purposes, and to determine the appropriate Service Level
and price� For more information regarding Declared Value, refer to
the FAQ on PSA’s website at www�PSAcard�com/resources/faq#104�
Please note: there is a maximum of 500 cards per order, please split
All charges must be paid in advance before PSA can process your order. Incomplete or illegible submission forms will delay turnaround time. PSA reserves the
right to correct your submission form to reflect its current authentication and shipping prices. If items are submitted for services for which they do not qualify,
signature below authorized PSA to correct the order and make any additional charges that may apply. All authentication charges are applicable regardless of
outcome.
I HAVE READ AND AGREE TO THE PSA TERMS AND CONDITIONS SET FORTH ON THIS FORM.
I ACCEPT FULL RESPONSIBILITY FOR COMPLETELY AND ACCURATELY FILLING OUT THE SUBMISSION FORM(S).
AUTHORIZED SIGNATURE (REQUIRED)
DATE
Order will not be processed without signature
TOTAL DECLARED VALUE $_____________
(REQUIRED)
Turnaround time does not begin until order has been entered
into the grading system. All terms and conditions are subject to
change. For up-to-date information, visit PSAcard.com.
PSA IS NOT RESPONSIBLE FOR ANY DAMAGE TO CARDS SUBMITTED IN HARD PLASTIC TOP LOADERS OR CARD SAVER II.
PSA
WILL
NOT
BE
RESPONSIBLE
FOR
INCOMPLETE
OR
INACCURATE
ORDERS.
QTY. CATEGORY SET NAME YEAR
CARD
#
CARD NAME
VARIETY
(If Any)
CURRENT CERT. #
(Reviews, Reholders
and Crossovers)
MIN. GRADE
(Required for
Crossovers)
NO
QUALIFIER
DECLARED
VALUE
EX. 1 Baseball Bowman Chrome 2011 175 Mike Trout Blue Refractor
$250
1
M
2
M
3
M
4
M
5
M
6
M
7
M
8
M
9
M
10
M
11
M
12
M
13
M
14
M
15
M
click to sign
signature
click to edit
PSA Customer Service (800) 325-1121
PSA TERMS & CONDITIONS
By signing the front side of this form,
Customer acknowledges that they have read
the PSA Grading Terms and Conditions (the
Agreement”) set forth below and agrees to
abide by this Agreement, and further agrees
that PSA is entitled to rely upon and benet
from this Agreement.
1. PSA will endeavor to grade cards within the
time frame, if any, offered as part of a PSA grad-
ing service� However, PSA will have no liability
whatsoever to Customer for incidental or conse-
quential damages due to PSAs failure to grade
any cards within any time frame� All days are
business days�
2. PSA will not grade cards which bear evi-
dence of trimming, recoloring, restoration or
any other form of tampering, or are of question-
able authenticity, and Customer agrees not to
knowingly submit any such cards� Customer
agrees that in the event PSA rejects any cards
for grading, PSA shall not refund the amount
paid by Customer because the determination to
reject a card requires a review by PSAs graders
and authenticators�
Customer represents and warrants that it has no
knowledge and no reasonable basis to believe
that any card submitted for grading has been
altered in any way or is not genuine� For
purposes of this Agreement, “altered cards
shall have the meaning set forth in the appli-
cable Dealer Agreement or PSA Collectors Club
Agreement by and between Customer and PSA
(theCustomer Agreement”)� If Customer has
not entered into the Customer Agreement, Cus-
tomer hereby agrees to be bound by the terms of
the Customer Agreement, a copy of which can
be found at PSAcard�com/join, and Customers
signature on this Agreement shall constitute
Customer’s signature on the Customer Agree-
ment� Customer rearms its obligations with
respect to Doctored cards set forth in the Cus-
tomer Agreement�
3. Grading involves individual judgments that
are subjective and require the exercise of profession-
al opinion, which can change from time to time�
ere fore, PSA makes no warranty or represen-
t ation and shall have no liability whatsoever to
Customer for the grade assigned by PSA to any
card, except pursuant to PSAs Financial Guaran-
tee of Grade and Authenticity Amount paid to
PSA is NON-REFUNDABLE once the item be-
gins the authentication and/or grading process�
4. An autographed item submitted under the
PSA card grading and autograph authentication
combination service must pass both autograph
authentication and card grading authentication
in order to be encapsulated� For example, a card
that is deemed altered in any way will not be
encapsulated even though the autograph may
be genuine� In addition, if the card is deemed
original and unaltered yet the autograph does
not pass inspection, then the card may not be
encapsulated� ere may be very rare exceptions
to the rule on a case by case basis (in cases where
the autograph and card are deemed authentic
but the card has been altered in some fashion)�
In a rare case where an authentic card has been
altered, PSA may choose to label the card “Au-
thentic” since the card cannot have a grade as-
signed� e final determination as to whether a
card is encapsulated under these conditions is
at PSAs sole discretion� Amount paid to PSA is
NON-REFUNDABLE once the item begins
the authentication and/or grading process
5. PSA will exercise reasonable care in han-
dling cards submitted for grading, review, or
reholdering. However, if PSA determines that
Customer’s card was lost or damaged while in
PSAs possession, Customer will be compen-
sated based upon the fair market value of the
card as determined by PSA standard procedures
which may include filing a claim with our in-
surance carrier� e declared value you stated
on the front of this form is for estimating the
insurance coverage only, and the fair market
value of the card may be less than your declared
value
IN NO EVENT SHALL THE TOTAL LI-
ABILITY EXCEED THE DECLARED VALUE
OF THE
CARD�
Such compensation shall be
Customer’s exclusive remedy for any loss or
damage� PSA reserves the right to decline your
Declared Value and to require you to pay for
the accurate Service Level as a condition of
completing the authentication and grading
process� For more information regarding De-
clared Value, refer to the FAQ on PSA’s website
at www�PSAcard�com/resources/faq#104
6. Customer must inspect all cards immedi-
ately upon receipt and PSA disclaims any liabil-
ity for damage or discrepancies or errors, includ-
ing, but not limited to, errors in the description
of the card unless reported to PSA within five
(5) days of Customer’s receipt of the card(s)�
Customer agrees to return any incorrectly de-
scribed card to PSA upon request for correction
and agrees to indemnify and hold PSA harmless
from any and all losses and/or claims caused by
the circulation or sale of incorrectly described
cards�
7. Customer agrees (a) to pay to PSA all pric-
ing and other charges when due; (b) that any
delinquent balances shall accrue interest at the
rate of 10% per year until paid (or, if less, the
maximum interest rate permitted by applicable
law); and (c) that PSA shall have a security in-
terest in the items submitted, as well as in any
other property of Customer in the possession
of PSA or its affiliates (collectively, the “Prop-
erty”), to secure payment thereof� Customer
hereby grants to PSA an assignment of and lien
against the Property in the amount of any pric-
ing and other charges due and payable pursuant
to the terms of this Agreement� Customer here-
by authorizes PSA to file, at any time on or after
the date such pricing totals and other charges
become due, appropriate uniform commercial
code financing statements in such jurisdictions
and offices as PSA deems necessary in connec-
tion with the perfection of a security interest in
the Property
8. PSA shall have no liability whatsoever to
Customer, or any third party for whom Cus-
tomer may be acting, (i) for any personal injury
or (ii) any damage to any card, or otherwise,
resulting from the breaking open of a PSA card
holder, or for any damage to any card that PSA
can reasonably demonstrate occurred while the
card was not in the custody or control of PSA
including, but not limited to, loss or damage to
cards while being shipped to PSA, or while be-
ing shipped by PSA to Customer by a method
selected and paid for by Customer�
9. Except as expressly set forth herein to the
contrary,
PSA DISCLAIMS ANY AND ALL
WARRANTIES, EXPRESSED OR IMPLIED,
REGARDING PSA’S GOODS AND SER-
VICES, INCLUDING, BUT NOT LIMITED
TO, THE WARRANTIES OF MERCHANT-
ABILITY AND FITNESS FOR A PARTICU-
LAR PURPOSE
10. Notwithstanding anything to the contrary
contained herein, except with respect to the
remedies under the PSA Financial Guarantee
of Grade and Authenticity set forth at PSAcard�
com (the “Guarantee”), THE MAXIMUM
AGGREGATE LIABILITY THAT PSA
SHALL HAVE TO CUSTOMER, OR ANY
THIRD PARTY FOR WHOM THE CUS-
TOMER MAY BE ACTING, ARISING
FROM ANY CAUSE, ACT, OMISSION OR
OTHER CIRCUMSTANCE, SHALL IN
NO EVENT EXCEED THE GRADING
CHARGES OR LESS ACTUALLY PAID BY
CUSTOMER FOR THE GRADING SER-
VICES RENDERED BY PSA WITH RE-
SPECT TO THE ITEMS SUBMITTED FOR
GRADING HEREUNDER� IN NO EVENT
SHALL PSA OR ANY OF ITS AFFILIATES,
OR ANY OF ITS OR THEIR RESPECTIVE
EMPLOYEES, OFFICERS, DIRECTORS
OR AGENTS, BE LIABLE TO CUSTOMER
OR ANY OTHER PARTY FOR ANY INDI-
RECT, INCIDENTAL, SPECIAL, CONSE-
QUENTIAL OR EXEMPLARY DAMAGES,
EVEN IF ADVISED OF THE POSSIBILITY
OF SUCH DAMAGES
11. In the ordinary course of its grading opera-
tions, PSA (i) compiles data regarding each card
submitted for grading, including, but not lim-
ited to, data relating to the identity, production,
condition and grade of the card (the “Data”);
and (ii) may take, or have taken, one or more
digital or other types of photographs, images
or reproductions of each such card (collectively,
the “Images”)� In consideration for the grading
services being provided by PSA, Customer, on
behalf of itself and any third party for whom
Customer may be acting, hereby authorizes PSA
(i) to compile and maintain such Data with
respect to each card submitted hereunder for
grading; and (ii) to take, or cause to be taken,
one or more Images of each such card, and fur-
ther agrees that PSA will be the owner of such
Data and all such Images and that PSA may use
and exploit such Data and the Images for com-
mercial and any other purposes, as PSA in its
sole discretion deems appropriate, including,
but not limited to, the publication and repub-
lication or reproduction in or on any media, of
such Data and Images� With out limiting the
generality of the foregoing, Customer, on behalf
of itself and any third party for whom Customer
may be acting with respect to this agreement,
unconditionally and irrevocably transfers, con-
veys and assigns to PSA any and all current and
any hereafter acquired rights, title and interests
(including, without limitation, rights in copy-
right, patent, trade secret and trademark) that
Customer or any such third party may have
in or to the Data and the Images (on whatever
media or in whatever form such Images may be
reproduced or published)�
12. If any cards are being submitted for a third
party, Customer represents and warrants that
such third party has agreed and accepted this
Agreement and has signed a duplicate copy
hereof where indicated� Customer agrees to pro-
vide that third party-signed copy to PSA at any
time upon its request
13. is Agreement is delivered and accepted in
the State of California and it is the intention of
the parties that it be governed by and construed
in accordance with the substantive laws of that
State, without regard to conicts of laws princi-
ples� e parties hereby consent to personal ju-
risdiction of the courts of the State of California
with respect to any legal action to enforce the
terms and conditions of this Agreement or oth-
erwise arising under or with respect to this
Agreement, and agree that the Superior Court
of California, County of Orange, or, if applica-
ble, federal District Court sitting in the County
of Orange, State of California, shall be the sole
venue, and the State of California shall be the
sole forum, for the bringing of such action�
Each of Customer and PSA agrees that the pre-
vailing party shall be entitled to an award of its
reasonable attorney’s fees, costs and expenses
14. e terms and provisions in this Agreement
and the Customer Agreement, if applicable,
constitute the entire agreement of PSA and Cus-
tomer (and any third party for whom Customer
may be acting) regarding, and supersede all
prior agreements and understandings (written
or oral) between or among such parties relating
to, the subject matter hereof� If it is determined
that there are any inconsistencies between this
Agreement and the Customer Agreement, then
this Agreement shall control� If any term or
provision of this Agreement is determined, by
a final and non-appealable ruling or order of a
court of competent jurisdiction, to be invalid
or unenforceable under applicable law, such in-
validity or unenforceability shall not aect the
validity or enforceability of any of the other of
the terms or provisions of this agreement� Each
party shall execute and deliver such additional
documents and instruments as any other party
may request to better evidence or effectuate the
agreements contained herein, including the as-
signment of rights set forth in Section 11, and
procedures, and further agree that PSA is en-
titled to rely upon and benefit from those terms
and procedures�
larger orders into quantities of 500� Each order of 500 cards will
require separate submission forms and Return Shipping�
4. No Qualiers (NQ): Cards that have significant flaws will
receive “qualified” grades (see definitions online at PSAcard�com)� If
you select this box and your card is determined to have a qualifier,
your card will be graded with a lower straight grade� For example,
what would be graded an ‘8 OC’ might be graded a straight ‘6�’ Please
note: Some qualifiers may not be removed
5. Calculate Service Level/Jumbo Holder Subtotal and Return
Shipping (see rate chart)� You must remit return postage for EACH
order unless you have your own shipping account with Federal
Express or USPS Express Service�
6. Tota l Cha rges and mark Method of Payment. Include check,
money order or credit card info� You must include payment or your
order will not be processed. Remit payment in USD.
7. Read terms and conditions below. Sign and date the front of the
form� Keep a copy for your records� Your order will not be processed
unless the submission form is signed�
8. Place each card in a flexible plastic pouch, such as a “Card Saver
I�” Pouch must be sturdy enough to protect item, but flexible enough
to allow us to remove item safely� Do not use hard acrylic holders,
screwdowns or top loaders
9. Package cards and submission form carefully. To help expedite
service, service level name must be marked clearly on the outside of
the package� If submitting multiple orders in the same package, please
mark the outside of the package with the highest service level� Failure
to do so may result in delays�
10. TURNAROUND TIMES:
e turnaround times listed on
PSAca
rd�com/pricing are estimates and only include Business Days�
While our staff works extremely hard to process submissions within
the time frame listed, the turnaround times are not guaranteed�
During the week of the National Sports Collectors Convention,
turnaround times will be impacted� Check the show schedule for the
specific dates�
11. Packages to PSA: United States Postal Service (USPS) and Federal
Express (FEDEX) are the only carriers accepted� We do not accept
items sent UPS, DHL, or any other shipping company� No exceptions�
YOU ARE RESPONSIBLE FOR INSURING ALL PACKAGES
TO US
a� USPS to: PSA, P�O� Box 6180, Newport Beach, CA 92658
b� FEDEX Express Service to: PSA, 1610 E� St� Andrew Place,
Suite 150, Santa Ana, California 92705
c� FEDEX Ground Service to: PSA, 1610 E� St� Andrew Place,
Suite 150, Santa Ana, California 92705
12. Packages from PSA (Return Carrier):
a� All orders are returned fully insured with signature required
b� FEDEX/USPS Express Mail: If requested, you must have your
own shipping account number and insurance coverage�
c� Do not send postage stamps, shipping materials or pre-paid
postage labels for the return of your package�
d� International shipments requesting specific shipping carriers,
may be charged additional Shipping charges�
e� For international shipments, the customer is liable for any
duties and taxes assessed on the shipment to and from PSA
f� Contact Customer Service if delivery of your returned
package is not made in 14 days of the shipment date
13. All terms and conditions are subject to change. For a complete
description of all PSA services and to view a list of the items PSA
authen ticates and grades, please visit PSAcard�com
©2021 Collectors Universe, Inc 105303 (card) Rev 02/21