Please allow a 2 week lead time
for order to be shipped.
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PLEASE PRINT CLEARLY
ITEM_________________________ QUANTITY____________________
ITEM_________________________ QUANTITY____________________
ITEM_________________________ QUANTITY____________________
TOTAL ITEM COST___________________
SHIPPING_____________________
3% Un-earned cash discount (all credit card orders)__________________
TOTAL_______________________
NAME_________________________________
ADDRESS_____________________________________ - WE CAN NOT SHIP TO
P.O. BOXES
_____________________________________
E-MAIL______________________________________________
Phone number________________________________________
I MUST HAVE YOUR E-MAIL ADDRESS OR A PHONE NUMBER TO CONTACT YOU
IN THE CASE OF A PROBLEM WITH YOUR ORDER.
Credit Card number__________________________________
CID/CVV #__________
Exp. Date.___________
I ____________________________ CERTIFY THAT I AM AT LEAST 18 YEARS OLD AND
AND
NOT IN VIOLATION OF ANY STATE OR FEDERAL LAWS IN PURCHASING,
RECIEVING OR
POSSESSING BLANKS OR AMMUNITION. I ALSO CERTIFY THAT I HAVE NO LEGAL
DISABILITY FOR THE OWNERSHIP OF AND/OR POSSESION OF FIREARMS AND
AMMUNITION. I ALSO UNDERSTAND THAT THE USE OF BLANK AMMUNITION IS
DANGEROUS AND DOES POSE A POSSIBLE RISK TO MYSELF AND OTHERS. I
UNDERSTAND THAT I AM USING THIS PRODUCT AT MY OWN RISK.
SEND ALL PAYMENTS TO:
Please note that personal checks will be held 10
business days before we ship.
Atlantic Wall Blanks
P.O. Box 1343
Mt. Vernon Ohio 43050