PROFESSIONAL SPORTS AUTHENTICATOR
P.O. Box 6180, Newport Beach, CA 92658
(800) 325-1121 • (949) 833-8824 • PSAcard.com
CARD SUBMISSION #
PACKAGE INFORMATION: (Customer Must Provide)
Customer Name:������������������������������������������������������������
1. Total number of orders included in this package: _____________________________
Customer #:����������������������������������������������������������������
2. Total number of collectibles included in this package (all orders): ______________
PSA USE ONLY
RETURN SHIPPING ADDRESS (print clearly)
_N AME_________________________________________________________ PHONE ( _____ )_________________________
_ADDRESS_______________________________________________________ EMAIL_________________________________
_CITY, STATE, ZIP___________________________________________________
o Check if permanent change of address
1. TYPE OF SUBMISSION: q Grading q Review q Crossover (one type per submission)
2. T YPE OF SERVICE: (One service level per submission form)
q PREMIUM PLUS† . . . . . . . . . . . . . . . . . . . . . . . . . . . $1200
Any card with a declared value of $25,000 or higher must be
­submitted at this service level.
2499092
ESTIMATED TURNAROUND: 1 Business Day
Any card with a declared value of $10,000 - $24,999 must be
­submitted at this service level or higher.
ESTIMATED TURNAROUND: 1 Business Day
q WALK-THROUGH†. . . . . . . . . . . . . . . . . . . . . . . . . . . . $250
Any card with a declared value of $5,000 - $9,999 must be
­submitted at this service level or higher.
ESTIMATED TURNAROUND: 1 Business Day
3. GRADING FEE CALCULATION _________ x $__________ = $___________
q REGULAR†. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $18
Any card with a declared value under $500 must be submitted at
this service level or higher.
ESTIMATED TURNAROUND: 10 Business Days
q PREMIUM† . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $800 q CUSTOM ENCAPSULATION (Green Label). . . . . . . . . . .
$7
Used for encapsulating custom-made trading cards, such as youth
league sports cards or personal photos. Four lines (max of 29 characters
per line) are available to customize the description.
ESTIMATED TURNAROUND: Varies by demand
q Supersized holder (over 3 1⁄2 x 5 1⁄8) . . . . . . . . . . . . . . . $10
q REHOLDER†
q SUPER EXPRESS†. . . . . . . . . . . . . . . . . . . . . . . . . . . . . $95
Any card with a declared value of $2,000 - $4,999 and all T3s must
be submitted at this service level or higher.
ESTIMATED TURNAROUND: 2 Business Days
q EXPRESS†. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Any card with a declared value of $500-$1,999 must be submitted
at this service level or higher.
ESTIMATED TURNAROUND: 5 Business Days
$45
e-encapsulation of PSA-graded trading card with any declared
qR
value for an expedited turnaround.. . . . . . . . . . . . . . . . . . $50
ESTIMATED TURNAROUND: 1 Business Day
q Re-encapsulation of PSA-graded card with a declared value
of $5,000 or higher.. . . . . . . . . . . . . . . . . . . . . . . . . . . . $35
ESTIMATED TURNAROUND: Varies by demand
q Re-encapsulation of PSA-graded card with a declared value
under $5,000.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $7.
ESTIMATED TURNAROUND: Varies by demand
q OTHER_______________________________________________________
†Supersized cards, coins and pins are available on each of the above services but must be submitted as a separate order with separate shipping and handling fees. This also
applies to crossovers and reviews. Failure to separate will result in additional fees 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 manufacturer) can be sent through any of the services listed
above (note restrictions and requirements for each level).
QTY. CATEGORY
EX.
1
SET NAME
Baseball
Bowman Chrome
# of items
grading fee
Alternate Return Shipping
(Must provide your own FedEx or USPS Express Mail account and insurance coverage)
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)
5. VOUCHER/CREDIT ON ACCOUNT������������������������������������������������ – $___________
6. TOTAL CHARGES �������������������������������������������������������������������������������������� = $___________
METHOD OF PAYMENT
q Credit Card
Check #_____________
Money Order #_________________________
Cardholder’s Name������������������������������������������������
Card Number
_____________________________________
Exp. Date���������
Cardholder’s Signature����������������������������������������������
CARD NAME
VARIETY
(If Any)
2011
Mike Trout
Blue Refractor
CURRENT CERT. #
(Reviews, Reholders
and Crossovers)
MIN. GRADE
NO
DECLARED
VALUE

$250
(Required for
Crossover) QUALIFIER
 1
M
 2
M
 3
 4
RC
RS O
 5
 6
 7
 8
 9
10
11
12
13
PSA
IS N
O
ADE
P LO RS.
O
T
RDE
STIC
PLA RATE O
D
R
U
A
C
IN H
NAC
TED TE OR I
T
I
UBM
PLE
DS S INCOM
R
A
FOR
TO C
AGE NSIBLE
M
A
O
YD
ESP
R AN T BE R
O
F
L NO
IBLE
ONS SA WIL
P
S
P
T RE
ARD
S
RI
AVE
I.
M
M
M
M
M
M
M
M
M
M
M
14
M
15
M
All fees must be paid in advance before PSA can process your order. Failure to include delivery or insurance fees will invalidate turnaround time guarantees.
PSA reserves the right to correct submission form to reflect current fees and appropriate shipping and handling fees.
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)
subtotal
4. USPS SHIPPING FEE (per order) — Select One:
q Domestic Postage, Insurance and Handling (see chart on reverse)
= $___________
q International Postage, Insurance and Handling (see Int’l. chart on reverse) = $___________
YEAR CARD
#
175
ORDER #_______________________
PKG #__________________________
Date Received___________________
Verified By______________________
Code__________________________
Order will not be processed without signature
DATE
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.
PLEASE SEE REVERSE FOR SUBMISSION INSTRUCTIONS AND TERMS AND CONDITIONS
Form not valid after 12/31/17
U.S.P.S. DOMESTIC POSTAGE, INSURANCE & HANDLING RATE CHART
PRIORITY MAIL
Number
of Items $1 – $1,000
EXPRESS MAIL
REGISTERED MAIL
TOTAL D E CLARE D VALUE
$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
$18.00
$29.00
$37.00
$44.00
$56.00
$64.00
$79.00
$120.00
$131.00
9 - 25
$24.00
$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.
INTERNATIONAL RETURN POSTAGE
Insurance Included – $100,000 Maximum
.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
SUBMISSION INSTRUCTIONS
 1.Print your name, customer number, return shipping address, email
­address and phone number in the space provided.
 2. Package Information (Required) — Be sure to fill out this section
­completely.
 3.Select the Type of Submission. Only one type of sub­mission at one
­service level is permitted per submission form.
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 fee will be charged.
REVIEW: For cards previously graded by PSA that you feel might be w
­ orthy
of a higher grade. Submit them in holders.
CROSSOVER: For cards previously graded by other companies. PSA will
evaluate the card inside the current holder. If PSA deems the card worthy to
cross over at the Customer’s specified minimum grade or higher, the card will
be removed from its holder and placed into a PSA holder. Regardless of the
result, the grading fee will be charged.
Please note: Customers using the Crossover Service MUST provide a
minimum grade on the submission form. If Customer is willing to a­ ccept
any PSA opinion, even if the result is evidence of trimming, questionable
­authenticity, etc., then write “Any” in the column. This may result in the card
being returned unholdered. If Customer is ­willing to accept any PSA grade,
then put “1” in the minimum grade column.
 4.List the description of each card. 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.
 5. No Qualifiers (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.
 6.Calculate Grading Fee and Shipping Cost (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. For international
shipments, the customer is liable for any duties and taxes assessed on the
shipment to and from PSA.
 7. Total Charges and mark Method of Payment. Include check, ­money
order or credit card info. You must include payment or your order will not
be processed.
 8. 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.
 9.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.
10. Package cards and submission form carefully. To help expedite service,
turnaround times 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 fastest turnaround time. Failure to do so may result in delays.
11.TURNAROUND TIMES: The turnaround times listed on the PSA
submission form 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 may vary. Check
the show schedule for the specific dates.
12. 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, 7000 Barranca Pkwy., ­Irvine, CA
92618 (Select “Hold at FedEx location” on air bill).
c.FEDEX Ground Service to: PSA, 1921 E. Alton Ave., Santa Ana,
CA 92705
13. Packages from PSA (Return Carrier):
a.A ll orders are returned via Priority, Express or Registered Mail depending on the declared value of the submission.
b.FEDEX/USPS Express Mail: If requested, you must have your own
shipping a­ ccount number and insurance coverage.
c.Do not send postage stamps, shipping materials or pre-paid postage
labels for the return of your package.
14. 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.
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 benefit from this
Agreement.
 1.PSA will endeavor to grade cards within the
time frame, if any, offered as part of a PSA grad­ing
service. However, PSA will have no liability what­
soever to Customer for incidental or consequential
damages due to PSA’s failure to grade any cards
within any time frame. All days are business days.
 2.PSA will not grade cards which bear evidence
of trimming, recoloring, restoration or any other
form of tampering, or are of questionable authen­
ticity, and Customer agrees not to knowingly sub­
mit any such cards. Customer agrees that in the
event PSA rejects any cards for grading, PSA shall
not refund the fee paid by Customer because the
determination to reject a card requires a review by
PSA’s 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 applicable PSA Autho­
rized Dealer Agreement or PSA Collectors Club
Agreement by and between Customer and PSA
(the “Customer Agreement”). If Customer has not
entered into the Customer Agreement, Customer
hereby agrees to be bound by the terms of the Cus­
tomer Agreement, a copy of which can be found
at PSAcard.com/join, and Customer’s signature
on this Agreement shall constitute Customer’s
signature on the Customer Agreement. Customer
reaffirms its obligations with respect to Doctored
cards set forth in the Customer Agreement.
 3. Grading involves individual judgments that are
subjective and require the exercise of professional
opinion, which can change from time to time.
There­fore, 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 PSA’s Financial Guarantee
of Grade and Authenticity.
 4. An autographed item submitted under the PSA
card grading and autograph authentication combi­
nation service must pass both autograph authenti­
cation 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. There may be very rare ex­
ceptions to the rule on a case by case basis (in cases
where the autograph and card are deemed authentic
©2017 Collectors Universe, Inc. 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 “Authentic” since
the card cannot have a grade assigned.
The final determination as to whether a card is
­encapsulated under these conditions is at PSA’s sole
discretion.
 5.PSA will exercise reasonable care in handling
cards submitted for grading, review, or reholder­
ing. However, if PSA determines that Customer’s
card was lost or damaged while in PSA’s possession,
Customer will be compensated based upon the fair
market value of the card as determined by PSA stan­
dard procedures which may include filing a claim
with our insurance carrier. The 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 LIABILITY
EXCEED THE DECLARED VALUE OF THE
CARD. Such compensation shall be Customer’s
exclusive remedy for any loss or damage.
 6.Customer must inspect all cards immedi­
ately upon receipt and PSA disclaims any liability
for damage or discrepancies or errors, including,
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 described card to PSA
upon request for correction and agrees to indem­
nify 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 fees 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 interest in the cards submit­
ted, as well as in any other property of Customer in
the possession of PSA or its affiliates (collectively,
the “Property”), to secure payment thereof. Cus­
tomer hereby grants to PSA an assignment of and
lien against the Property in the amount of any fees
and other charges due and payable pursuant to the
terms of this Agreement. Customer hereby autho­
rizes PSA to file, at any time on or after the date
such fees and other charges become due, appropri­
ate uniform commercial code financing statements
in such jurisdictions and offices as PSA deems nec­
essary in connection with the perfection of a secu­
rity interest in the Property.
 8.PSA shall have no liability whatsoever to Cus­
tomer, or any third party for whom Customer 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 being 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 PARTICULAR
PURPOSE.
10.Notwithstanding anything to the contrary
con­­­tained herein, except with respect to the rem­
edies 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 CUSTOMER MAY BE ACTING,
ARISING FROM ANY CAUSE, ACT, OMIS­
SION OR OTHER CIRCUMSTANCE, SHALL
IN NO EVENT EXCEED THE GRADING FEE
OR LESS ACTUALLY PAID BY CUSTOMER
FOR THE GRADING SERVICES RENDERED
BY PSA WITH RESPECT TO THE CARDS
SUBMITTED FOR GRADING HEREUNDER.
IN NO EVENT SHALL PSA OR ANY OF ITS
AFFILIATES, OR ANY OF ITS OR THEIR
RESPECTIVE EMPLOYEES, OFFICERS,
DIREC­
­
TORS OR AGENTS, BE LIABLE TO
CUSTOMER OR ANY OTHER PARTY FOR
ANY INDIRECT, INCIDENTAL, SPECIAL,
CONSEQUENTIAL OR EXEMPLARY DAM­
AGES, EVEN IF ADVISED OF THE POSSI­
BILITY 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 limited
to, data relating to the identity, production, condi­
tion 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 con­
sideration 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 here­
under for grading; and (ii) to take, or cause to be
taken, one or more Images of each such card, and
further 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 commercial
and any other purposes, as PSA in its sole discre­
tion deems appropriate, including, but not limited
to, the p
­ ublication and republication or reproduc­
tion in or on any media, of such Data and Images.
With­out limiting the generality of the foregoing,
PSA Customer Service (800) 325-1121
Customer, on behalf of itself and any third party for
whom Customer may be acting with respect to this
agreement, unconditionally and irrevocably trans­
fers, conveys and assigns to PSA any and all current
and any hereafter acquired rights, title and interests
(including, without limitation, rights in copyright,
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 indi­
cated. Customer agrees to provide that third partysigned copy to PSA at any time upon its request.
13.This 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 conflicts of laws principles. The
parties hereby consent to personal jurisdiction of
the courts of the State of California with respect to
any legal action to enforce the terms and conditions
of this Agreement or otherwise arising under or
with respect to this Agreement, and agree that the
Superior Court of California, County of Orange,
or, if applicable, 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 prevail­
ing party shall be entitled to an award of its reason­
able attorney’s fees, costs and expenses.
14.The terms and provisions in this Agreement
and the Customer Agreement, if applicable, con­
stitute the entire agreement of PSA and Customer
(and any third party for whom Customer may be
acting) regarding, and supersede all prior agree­
ments and understandings (written or oral) be­
tween 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 rul­
ing or order of a court of competent jurisdiction,
to be invalid or unenforceable under applicable
law, such invalidity or unenforceability shall not
affect 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 agree­
ments contained herein, including the assignment
of rights set forth in Section 11, and procedures,
and further agree that PSA is entitled to rely upon
and benefit from those terms and procedures.
628506 (card) Rev 11/16