As a contributor to the HHG, you are eligible to receive special benevolence from Luck "E" Penny... but you MUST enter your name and email address below (this information will remain confidential - to be used only as an internal checking system for special offers that relate to HHG contributors).

*Your Name


*Your E-Mail


Mailing Address (optional)

Machine Location

*COUNTRY:

*STATE: SELECT STATE ALABAMA ALASKA ARKANSAS ARIZONA CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHEUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING    *City/Town:

Establishment's Name:

Establishment's Address:

Establishment's Phone Number:

Number of machines at this location:

Additional Comments on machine's location:


Machine Information

Name of Manufacturer: Electric Hand-cranked

Number of dies on machine:   Cost for rolling coin:

Denomination of coin that gets elongated (eg. penny, nickel, etc.): PENNY NICKEL DIME QUARTER OTHER - DESCRIBE BELOW

Additional comments on type of machine:


Die information:

	Orientation	Border (choose one)	Text on Coin	Image on Coin
#1	Horizontal Vertical	DOTTED LINE NONE OTHER
#2	Horizontal Vertical	DOTTED LINE NONE OTHER
#3	Horizontal Vertical	DOTTED LINE NONE OTHER
#4	Horizontal Vertical	DOTTED LINE NONE OTHER

Additional comments:



If you have easy access to this machine, and would like to be contacted by elongated coin collectors seeking coins from this machine, Luck "E" Penny will gladly list you as a contact. Please be sure to include your name and e-mail address above. This could be your opportunity to really build your collection by trading with others, or perhaps earn enough money to buy that rare elongated that you've been dreaming about!