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Precious Metal Destruction Form

Please complete the following form for Precious Metal Sale or Destruction and click submit.

Business Name :  
 Date : 
 Item Description :   
 Serial Number :  
 Date Purchased :   
 Seller's Name :   
 Age :   
 Sex :   
 Driver's License :   
 Issuing State :   
 Reason for Request :   Resale of Item     To be Shipped    
 Scrap/Melt Item
 Approved By :   
 ID # :   
 Date :