********** 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.