Mayer Mint Gmbh

Mayer Mint Registration Form

Username and Password

*User Name:

*Password:

* Re-Type Password:

*Current E-mail address:

Username and Password

*Title:

*First Name:

Middle Initial:

*Last Name:

*Birthday:

(dd/mm/yyyy)

*Street 1:

Street 2:

*City:

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*Country:

Home Telephone:

Office Telephone:

Mobile Telephone:

Fax:

My Interests

For the continuous improvement of the web site, please kindly answer the following questions:

1)Which of the following best describes your interest with Mayer Mint's product?

2) What do you collect?

Coins	Antiques
Stamps	Villages, Cottages, Wooden cutout
Vehicles & Models	Display Accessories
Dolls	Sculpture
Music Boxes	Others:

3) Area of Interest

Entertainment	Sweepstakes & Free Stuff
Shopping	Business
Home & Family	Computer & Technology
Sports & Outdoors	Health
Personal Finance	Travel
Music	Small Business

By submitting your registration information, you indicate that you agree to the Term of Service and have read and understood the Mayer Mint Privacy Policy. Your submission of this form will constitute your consent to the collection and use of this information and you also agree to receive required administrative and legal notices such as this electronically.