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Please print form, fill out completely and email, fax or mail to:

Goldbelt, Incorporated
3075 Vintage Blvd Suite 200
Juneau, Alaska 99801

FAX:  (907) 790-4999

EMAIL:  mail.shareholder@goldbelt.com

Shareholders may download the current Adobe Reader – click here. If you are unable to utilize Acrobat Reader and PDF files please call Goldbelt at (907) 790-4990 or toll free at (800) 770-5866 to request delivery of a form by mail.

The protection of shareholder records is an absolute requirement both of Goldbelt, Incorporated and Federal law. For your information, please see Protection of Shareholder Records Statement.