Date   (mm/dd/yy)

Please provide the following Contact Information:

First Name
Last Name
Middle Initial
Title
Daytime Phone	Weekday
Cell Phone
E-mail

Shipping Address - weekday delivery  (NO PO Box)

Organization
Street Address
Address (cont.)
City
State
Zip/Postal Code
Country

 

Please check one of selections:

Civilian
Law Enforcement (enclose ID)
Military (enclose ID)
Dealer (enclose FFL)

          Please provide your item information:

Manufacturer
Model
Serial Number

To be sighted in with (name of Bullets)       Weight (gr.)       

Distance out to 25 yards (yards)

Work Requested

If you have any Special Remarks and Supplied Parts, please list them below.

If you would like to pay via Credit Card, please fill in the following information after you print this form;

Visa
American Express
Master
Discover

Cardholder's Name
Card Number
Expiration Date
Signature