Place drivers license here and copy form.

This form certifies that there are no local laws or ordinances in my State or Locality which prohibit me from receiving ammunition shipped to my residence or business.

Signature:_______________________________

This form must accompany all orders, and must be on file before any ammunition order can be shipped. Please note that a street address is required for U.P.S. deliveries.

Quantity     Caliber          Bullet Weight / Type                                                                 Price

Mail completed form                 Safari Arms Ltd.                      Tel: 516-826-7516         

with payment to :                        P.O. Box 1825                         Fax: 516-221-9721

Safari Arms Ltd.                      Seaford, NY 11783                    Email: info@safariarms.com          

Credit Card payments are accepted by telephone or fax.