Directions:
1) Print out this form
2) Read it and sign the bottom
3) Fax to (508) 835-3690

Invoicing Department; This letter is to certify that I am 21 years or older and there are no State or Federal laws prohibiting me from buying and receiving this ammunition. All visitors are required to read the following disclaimer, prior to ordering ammunition from Wayne's Weaponry. Armor Piercing, Penetrator and Tracer is not available to residents of some states. Check your local and State laws. This ammunition is sold on the representation that it will be used in accordance with all Federal, State and Local laws. Misuse of this ammunition may cause serious personal injury or death. No warranties, expressed or implied are made as to the fitness or suitability for any purpose. Wayne's Weaponry has no control over the end use. The buyer assumes all liability from its use and or resultant damage.

WARNINGS: To avoid injury use only in new firearms or firearms that are in good condition. Always verify the rifle and ammunition caliber of your firearm before loading. Always be certain the barrel is in no way obstructed. Wear safety glasses and ear protection when discharging. If your weapon fails to fire be sure to point the weapon down range for at least 60 seconds. When clearing a misfire avoid exposure to the breach. Do not attempt to re-fire a misfire.

WARRANTIES: Wayne's Weaponry exercises reasonable care in the selection of all merchandise, products and materials. There are no warranties expressed or implied, or otherwise as to the serviceability or use of the products expressed herein.

Your Name:______________________________________

Address:_________________________________________

City:__________________State:_______Zip:___________

Phone # ______ ______ ___________

Email address___________________@___________________________

(Shipping Address)

Name:_________________________________________

Address:_______________________________________

City:__________________ State:________ Zip:__________

Date:_____________ Name:_______________________________(signed)