Your Name * Company Name (Optional) Address 1 (No PO Boxes)* Address 2 (Suite, Apt, etc.. Optional) City * State * Zip *
Primary Phone # * Alt Phone # * Your Email *
Payment: Pay Online (Visa/MC)Money Order (USPS Discouraged)Check EnclosedCash Enclosed
My Firearm: Firearm Make/Model: * Serial #: *
What I Want: Assemble OnlyAssemble + ParkerizeAssemble + Refinish Black over Parkerizing Other Instructions
Extra/replaced parts should be: Kept to 'Pay It Forward'Returned with Firearm
Ship your firearm and a copy of this document to: