LAW ENFORCEMENT/MILITARY ORDER FORM

Full Name*
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Agency/Branch of Service*
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Billing Address*
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Phone*
Model Being Purchased*
Price Per Model*
Purchasing Officer’s E-Mail*
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FFL Name*
FFL Email Address
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FFL Address*
Street Address City State ZIP Code
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Consent*
Agreement
This statement, made under penalty of perjury, is certification that I am a law enforcement officer, serving in the military, or honorably discharged. I further certify that I have no convictions for misdemeanor crimes of domestic violence or domestic violence assault, and that this firearm is being purchased for personal use, and not for purposes of transfer or resale.
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