Parts / Accessories Order Form Shipping Instructions   Latest Version of Microsoft Internet Explorer or Mozilla Firefox is required to use this form. Download the latest version for free @ Mozilla or Microsoft.

Customer Information
First Name				Is this your first order? Yes No
Last Name				Backorder OK? Yes No
Organization				SELECT ONE Commercial Residential
Address
City
State / Province
ZIP / Postal Code
Country
Email Address
Phone
Fax

Quantity	Item Number / Description	Price Each	Total
Subtotal
SALES TAX - Louisiana Residents Only ...		Add 4%
Select Preferred Shipping Method FedEx Ground (under 1 lb) $ 7.50 FedEx Ground (2-4 lbs) $ 10.00 FedEx Ground (5-8 lbs) $ 15.00 Priority Mail (under 1 lb) $ 7.50 + $ 5.00 FedEx residential deliveries		Shipping
		Total

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

	Amount $:
Method of payment: Select Payment Method VISA MASTER CARD DISCOVER COMPANY CHECK PERSONAL CHECK Money Order Certified Check Card Number - - - Expires Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Year 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020	Name as it appears on card: Credit card billing address: City, State & Zip

Complete form, Print, then mail, Fax 318-949-9829 or Order toll free @ 888-458-4126.
NOTE: Minimum Order $ 30 (excluding shipping)
Clark Custom Guns, Inc.
336 Shootout Lane
Princeton, LA 71067 USA