Revolver 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			DEALER INFO (complete gun orders only) FFL is already on file with your company FFL is attatched to this order Will send FFL later
Last Name
Organization
Address
Address
City			Gun Information
State / Province			Make
ZIP / Postal Code			Model
Country			Caliber
Phone			Serial Number
Fax
Email Address
	INSTRUCTIONS
Conversion	SWBM (Bo-Mar Rib) SWAR (Aristocrat Rib) SWCM (Weaver Base) SWLWR SWGM
Service / Option #1
Service / Option #2
Service / Option #3

Additional Comments or Instructions: Please type any Special Instructions and/or comments Here

No Deposit is Required.	Amount $:
Method of payment: Select Payment Method VISA MASTER CARD Discover COMPANY CHECK PERSONAL CHECK	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 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Year 2004 2005 2006 2007 2008 2009 2010	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

TERMS

• Conversions / Services only performed on S&W or Ruger Revolvers
• No deposit required for work to be performed on customer's gun. $ 100.00 Deposit required when ordering a complete gun.
• Canceled work orders are subject to a $ 25 cancellation fee and customer is responsible for any work already performed and return shipping charges.
• Please do send any factory magazine(s) that will be used with the rifle.
• Once your custom work is completed, a final invoice for the balance will be mailed to the address below.
  
  Failure to pay this invoice or make other arrangements within 60 days of invoice date will result in your pistol being sold for charges due
• Payment may be made by MasterCard, Visa, Discover, Money Order or personal check.
• PERSONAL CHECKS WILL BE HELD 14 DAYS prior to shipping.
• All work order changes will be assessed a charge of $25 per change and may alter estimated completion date.
• All order change requests must be submitted in writing by fax, e-mail or snail mail.
• When shipping complete revolver, please ship insured by next day service via UPS or FedEx: CCG, 336 Shootout Lane, Princeton, LA 71067.
• Custom work will be scheduled upon receipt of firearm and/or deposit and a signed work order form.
• Due to Federal regulations, customer's firearms must be returned to address from which they were received. If you have a change of address, written notification by e-mail, snail mail or fax is required.
• Return shipping for most revolvers is $ 45 - $ 60.

I have read, understand, and agree to the above terms and understand that delivery times estimated are strictly approximate and may vary considerably due to factors out of our control. I also understand that specifications are subject to change due to product improvements and parts availability. Having read and understood these terms, I hereby authorize the above custom work to be performed on my gun.



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	Date	Signature