CUST

^{CUST # IF KNOWN}	^{HOME PHONE}
^NAME	^{WORK PHONE}
^{MAILING ADDRESS}	^{SHIPPING ADDRESS}
^{CITY, STATE, ZIP}	^{CITY, STATE, ZIP}

Payment by: Check › Money Order › Visa › MasterCard › Add 4% for V/MC

^{CREDIT CARD #}

^{EXPIRATION DATE}

^{NAME ON CARD}

^SIGNATURE

QTY	ITEM		PRICE EA	TOTAL
1.
2.
3.
4.
		SUBTOTAL
		VISA OR HAZ MAT CHARGE
		ESTIMATED SHIPPING
		ORDER TOTAL

You can print this page to place an order or e-mail the above information (you must have an Age Statement on file BELOW) to ammoking@bigskysurplus.com Minimum order $ 50.00

AGE STATEMENT -- PRINT THIS FORM AND SUBMIT WITH YOUR ORDER

I am over 18 years old (21 for pistol ammo) and there are no local, state or federal laws prohibiting me from purchasing this merchandise.

Print Name