********** STATEMENT ***********

I,____________________________ AM OVER THE AGE OF 21.

MY BIRTHDATE IS: _________________.

THERE ARE NO FEDERAL, STATE, OR LOCAL LAWS THAT PROHIBIT ME, THE UNDERSIGNED, FROM PURCHASING OR RECEIVING THIS AMMUNITION.

SIGNATURE:_____________________ DATE:____/____/_______

ADDRESS:_________________________CITY:_____________STATE:____ZIP:________

PHONE:(____)_______________________ E-Mail:__________________________

STATEMENT MUST BE SIGNED AND DATED !

  • WE MUST HAVE A CLEAR COPY OF YOUR DRIVER'S LICENSE SHOWING YOUR ADDRESS.
  • WE WILL ONLY SHIP TO THE ADDRESS ON YOUR DRIVERS LICENSE!
  • IN THE EVENT WE ARE SHIPPING ELSEWHERE, WE MUST HAVE A STATEMENT (eg. UTILITY BILL-WITH YOUR NAME AND ADDRESS) TO PROVE THAT YOU ARE LOCATED AT THE SHIPPING ADDRESS.
  • THE ABOVE STATEMENT AND DRIVER'S LICENSE MAY BE FAXED TO US AT: (402)334-0777.