Conversion / Services Order Form
Complete form, Print out and Ship to CCG, Inc., 336 Shootout Lane, Princeton, LA 71067
Shipping Instructions  

    Customer Information

    First Name

    Last Name

    Organization

    Address

    Address

    City

    		Gun Information
    State / Province

    		Make
    ZIP / Postal Code

    		Model
    Country Caliber

    		Serial Number
    Phone

    Fax

    Email Address
     
    INSTRUCTIONS
    Conversion
    Code

    		Rifle Conversions Only.
    Option #1
    Option #2
    Option #3

    Additional Comments or Instructions:

    No Deposit is Required. Amount $:
    Method of payment: If you wish to include payment information at this time, please note that your card will not be charged until work is completed. Please fill in only if different from information above.
    VISA, MC or Discover:
    - - -
    Expires /     		Name as it appears on card:

    Credit card billing address:
    City, State & Zip

    Print this form and include with your firearm.
    You may also fax to 318-949-9829
    Clark Custom Guns, Inc.
    336 Shootout Lane
    Princeton, LA 71067 USA
    888-458-4126

     

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