Todays Date Cust. Daytime Phone # Cust. Fax#

Customer Name Address

City State Zip Cust. Email

MC/ VISA/ DISCOVER/AMEX   NUMBER :
EXP DATE

Security code (located in the signature line last three numbers)

Customer Signature ___________________________________________

If Credit card billing address is different than shipping please fill out forms below

Address  City State Zip

Please send my order by (date)-OR-

QTY

ITEM#

ITEM DESCRIPTION (BE SPECIFIC!)

COLOR

SIZE

PRICE

IF ORDER TOTALS...

PLEASE ADD

$10.00 or less --------------------$6.95
$10.01 TO $25 ------------------  $12.00
$25.01 T0 $50 --------------------$14.95
$50.01 T0 $75 -------------------$16.95
$75.01 T0 $125 -----------------$18.95
$125.01 OR MORE------------$21.00
Any Firearm -------------------$25.00

SUBTOTAL

<------Shipping, Handling, Insurance

7% MS Sales Tax

TOTAL

Large orders quoted separately