Parts / Accessories Order Form 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 1. Full Name 2. Organization / Company 3. Address Choose One Commercial Residential Unknown 4. Address 5. City 6. State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY 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% 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 (small parts) $ 5 (up to $ 100 product) Shipping + $ 5.00 FedEx residential deliveries Total Credit card billing address: (if different than ship to) Method of payment: Select Payment Method VISA MASTER CARD DISCOVER PERSONAL CHECK Certified Check / Money Order 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 AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Additional Comments or Instructions: Special Instructions / Comments Complete form, Print, then mail, Fax 318-949-9829 or Order toll free @ 888-458-4126 M-F 8 am - 4 pm CST NOTE: Minimum Order $ 20 (excluding shipping) Clark Custom Guns, Inc. 336 Shootout Lane Princeton, LA 71067 USA
Additional Comments or Instructions: Special Instructions / Comments