Parts
Order Form  
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Customer Information
1. Full Name  
2. Organization / Company  
3. Address  
4. Address  
5. City  
6. State  
7. Zip Code  
8. Email  
9. Phone  
10. Fax  
Is this your first order? Yes No Back Order OK? Yes No

Quantity
Item
Number
Description
Price
Each
Total
     
Subtotal
   
SALES TAX - Louisiana Residents Only ...
Add 4%
   
Shipping
 
Contact us for alternative shipping methods
     
Total
SHIPPING NOTE: Priority Mail pricing is for the small flat rate box.
Inside Dimensions: 8 5/8" x 5 3/8" x 1 5/8"
Check Here if it's OK for us to unpackage products to fit in small flat rate box.

  Credit card billing address:
(if different than ship to)
Method of payment:
Card Number
- - -
Expires /
CVV # REQUIRED (what's this?)



Additional Comments or Instructions:

Complete form, Print, then mail, Fax 318-949-9829
or Order 318-949-9884 M-F 8 am - 4 pm CST
NOTE: Minimum Order $ 20 (excluding shipping)
Clark Custom Guns, Inc.
336 Shootout Lane
Princeton, LA 71067 USA