Palm PDA M500 Order Form Price: $335.00 GST Inc

You can type in most of your details before you print this page, apart from the Police Info! Then please print this page, have a member on the police sign it and post it to Combloc Supplies.
All Rifle and Ammunition Orders must have a copy of your Firearms Licence Attached!

To purchase firearms or ammunition you are legally required to fill out this form. Please provide as much of the following contact information as possible:

Name

Street address

Address (cont.)

City/Town

Province

Postal code

Country

Home Phone

Cell Phone

Fax Number

E-mail

Please Sign Here________________________________

Police Officer to complete if purchasing a firearm or ammunition.

I have inspected the firearms license of

__________________________________________________________________

And I am satisfied that they are a fit and proper person and the firearms license held by the purchaser entitles them to buy the items listed above.

Signed:____________________________ Badge No__________________________

Date:______________________________

Name:________________________________________________________________

Station address:_______________________________________________________

Station Phone number:______________________  

Post to:
Combloc Supplies Ltd
PO Box 251
Hawera, New Zealand
or Fax to: (06) 278 5082