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 Business Residence
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 Shipping Method UPS Ground UPS 3 Day Select UPS 2nd Day Air UPS Next Day Air Priority Mail Minimum $ 7.50		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 2007 2008 2009 2010 2011 2012 2013	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 $ 20 (excluding shipping)
Clark Custom Guns, Inc.
336 Shootout Lane
Princeton, LA 71067 USA