NOTE: IF YOU DO NOT HAVE A FFL, THIS FORM NEEDS TO BE FILLED OUT.

TO PURCHASE RESTRICTED ITEM(S); WE REQUIRE THE PURCHASER SIGN AND DATE THE PURCHASE CERTIFICATION FORM BELOW THIS TEXT.

So we can quickly process your order. Please fax or email us a copy of this statement signed by the purchaser along with a copy of a valid and current government issued identification (Drivers License) showing the purchasers date of birth and current address.

 

TO: COLLECTOR FIREARMS. RANDALL M. BESSLER L.L.C. P.O. BOX 8 CARSON CITY NEVADA 89702 (775) 885-0717.

PURCHASE CERTIFICATION:

BY SIGNING AND DATING BELOW, I CERTIFY THAT I, THE PURCHASER IS NOT RESTRICTED AND IS NOT PROHIBITED BY ANY FEDERAL, STATE, OR LOCAL LAW TO PURCHASE RESTRICTED ITEM(S) IN THIS ORDER. I'M ALSO FULLY AWARE OF ALL FEDERAL, STATE, AND LOCAL LAWS PERTAINING TO RESTRICTED ITEM(S) PURCHASES.

IN REGARDS TO RESTRICTED ITEM(S) ORDERED, I HERBY CERTIFY THAT I MEET THE MINIMUM AGE REQUIREMENT OF 21 YEARS OF AGE.

I ALSO UNDERSTAND THAT ANY RESTRICTED ITEM(S) PURCHASED IS SOLD TO ME IN 'AS-IS' CONDITION. AS A COLLECTORS ITEM ONLY WITH NO GUARANTEE AS TO ITS ACTUAL FUNCTIONALITY, SUITABILITY FOR USE, OR SAFETY. 

I ALSO CERTIFY THAT I AM PURCHASING THIS ITEM(S) FOR MYSELF ONLY AND IT WILL NOT BE TRANSFERRED TO ANY PERSON PROHIBITED FROM OWNING THIS RESTRICTED ITEM(S) UNDER ANY FEDERAL, STATE OR LOCAL LAWS. 

 

                       Purchasers Signature & Date                                     Drivers License Number  

                      

                       Printed Name                                                                Address, State & Zip