Mail Order Form
Please fill in the
following information for your order. Note that all personal
information, including email address is required! At the end of the
form you will find a short statement to sign concerning your being
legally able to order and receive these products. NO ORDERS WILL BE
SENT WITHOUT THIS BEING SIGNED!! Prices effective Dec 1, 2012 and supercede any other listing. NAME , SHIPPING ADDRESS, STREET ADDRESS ONLY, NO PO
BOXES! , CITY, STATE, ZIP , EMAIL ADDRESS , DAYTIME PHONE (IN CASE THE DELIVERY TRUCK NEEDS HELP FINDING YOU) ,
Your Order MAY be mixed powder granulation(s), - Just make a notation as to the
mixture you would like. All cases have 12 bottles. MAKE SURE YOUR MIXED CASE ORDER TOTALS 12!
FULL CASES APP 2F, 12/case,
$243.90/CASE CASE(S) , FULL CASES APP 3F, 12/case.
$243.90/CASE CASE(S) , MIXED CASES APP 2F/3F, $243.90/CASE-HOW MANY OF EACH? CASE(S) , CASES 50 Grn 45 Caliber
STICKS™, 12/case, $273.90/CASE CASE(S) , CASES 50 Grn 50 Caliber
STICKS™, 12/case, $273.90/CASE CASE(S) , CASES 100 grain
Pre-Measured Loads™, 12/case, $243.90/
CASE CASE(S) , FULL CASES 150 grain
Pre-Measured Loads™, 12/case, $243.90/
CASE CASE(S) FULL CASES JIM SHOCKEYS
GOLD™ 2F, 12/case, $254.90/CASE CASE(S) FULL CASES JIM SHOCKEYS
GOLD™ 3F, 12/case, $254.90/CASE CASE(S) FULL CASE JIM SHOCKEYS
GOLD™ MIXED 2F/3F, $254.90/
CASE CASE(S) FULL CASE JIM SHOCKEYS
GOLD™ STICKS™,$282.90/
CASE CASE(S) , , ,
REQUIRED STATEMENT
I, by my signing this statement, certify that there are no local, state or federal laws or regulations that would either prohibit my purchase and delivery or that would require additional actions to conform to regarding my order and delivery of American Pioneer powder or STICKS compressed charges and that I am at least 18 years of age and legally responsible for my actions. This includes any zoning or fire department regulations concerning the storage and possession of these products. I also certify that I will only use these products in a safe and legal manner, and hold any and all parties involved in the manufacture, shipment or sale of these products harmless and free from liability for any of my actions, either intentional or accidental, during the use or storage of these products. I am familiar with the safe use of these products and the firearms that they are intended to be used in, and I will use these products in a safe and legal manner at all times. I understand that firearms and the ammunition and/or components are, by their very nature dangerous and that the use or possession of either or both may result in death or injury to those around, whether or not they are personally using the products. I also understand that these products are not warranted for any particular use or application.
______________________________________________________
Mail completed form and payment to:
Glen R. Parshall, TheSpiritOf76.com, 4605 E. Monroe Ave, Las Vegas, Nevada 89110
Make payable to Glen R. Parshall