| Date: __________________________________ |
| Name: ___________________________________________________________________________________________ |
| Street Address (No P.O. Boxes Please!): _______________________________________________________________ |
| City: ____________________________________________________________________________________________ |
| State: ___________________________________________________ Zip: ____________________________________ |
| Telephone number where we can contact you: __________________________________________________________ |
| e-mail address:_________________________________________________________________________________________ |
| Type of ammunition used:____________________________________________________________________________ |
| Description of your problem: _________________________________________________________________________ |
| _________________________________________________________________________________________________ |
| _________________________________________________________________________________________________ |
| _________________________________________________________________________________________________ |
| _________________________________________________________________________________________________ |
| _________________________________________________________________________________________________ |
| _________________________________________________________________________________________________ |
| _________________________________________________________________________________________________ |
| _________________________________________________________________________________________________ |
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To prevent damage, please ensure that you package your firearm well when you ship it.
Please include this form with your firearm.
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