Bellmore Philatelics, Inc. · 1000 Park Blvd. Suite 209 · Massapequa Park · NY · 11762
VOICE: (516)882-9345 · FAX: (516)882-9005
PLEASE PRINT OUT AND FAX THIS INFORMATION SHEET TO (516)882-9005
Last Name, First Name___________________________________________________
Address_______________________________________________________________
City________________________________ State______ ZIP___________+_______
Day Phone_______________ Evening Phone_______________ Cell_______________
Email address________________@________________
1. Time Period Desired (Circle appropriate letter)
a. 1840-1940
b. 1840-1960
c. Other: ________________
2. Mint / Used (Circle appropriate letter)
a. Mint only
b. Used only
c. Mint or Used
3. Areas (Please circle all that apply)
a. Great Britain, Dominions & Colonies
b. France and Colonies
c. Other European Colonies
d. Western Europe
e. Eastern Europe
f. Latin America
g. Asia
h. Africa
i. United States / Canada
k. Worldwide
4. Other comments that would be helpful:
________________________________________________________________
________________________________________________________________
Thank you for your time. We will be in touch with you momentarily.