Company Name:___________________________________________________

Name:___________________________________________________________

Street Address:____________________________________________________

City:______________________ State:_____________ Zip:_______________

Day Phone:_____________________ Evening Phone:____________________

e-mail:___________________________

Gun Model ________________________ Serial # _______________________

Special Instructions:________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

CREDIT CARD ORDERS

Card # ___________-___________-___________-__________ Exp: _________

3-Digit Code ___________

_____ Return any extra/replaced parts OR

_____ Keep any extra/replaced parts for others who might need them.

(Revision 050717)