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  • Print out this form, fill it out and fax to: 270-282-4896     24/7
  • PLEASE PRINT LEGIBLY OR WE CANNOT RESPOND BACK.
  •   Name:________________________________________________________

    Address: ____________________________________________________
    For credit card orders, this MUST match your card's billing address.
    Otherwise, you risk that your card may be declined by the bank, your
    order can not be processed without it.
    Item can be shipped  to different address, but list that address below in comments section.

    City/ State/ ZIP: ___________________________________________

    Phone (daytime):___________________________________________

    Credit Card number:________________________________

    Expires on:_______________

    Last three numbers on back of card : _____________
    (four numbers on front  if AMEX)

    E-Mail Address:__________________________________

    Make:____________________________________

    Model Number:____________________________________

    Year of Manufacture (if known):__________________

    Caliber or Gauge:________________________________

    Ram-Line Part Number :_____________________________

    Specific Part Description: You can also use this space for additional comments


     

     

     

     

     

     

     

      Thank you for contacting us, confirmation of order may take 1-2 days.

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