Please print out this page and fill in the blanks.

  Please print so that we can read it.
You can mail, scan & email or fax the completed page to us.

REVOLVER ARMORER
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Your Billing Address and Shipping Address must be the same

First Name:
______________________________________________________
Last Name:
______________________________________________________
Street Address:
______________________________________________________
City:
______________________________________________________
State or Providence:
______________________________________________________
Country:
______________________________________________________
Email Address:


_______________________________________________________________________________________
     Item#          Decription        Qty            Price                  Total
_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

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                                                                      Subtotal:
                                                                      Shipping:
                                                                      Total:
                                                                       ==============

Mastercard or Visa: _________________

Name on Card: _________________________________

Credit Card Number:_____________________________

Expiration date: ______________

CCV Number on back of card: ___________________


Signature _______________________________

Once completed you can mail,  fax or scan and email the form to us.

Our fax number is: 1-757-942-2410

Our mailing address is: 
REVOLVER ARMORER
3921 Nansemond Parkway
Suite D
Suffolk Virginia 23435