DATE:

NAME:

YOUR ADDRESS:

CITY:STATE OR PROVINCE:

ZIP/POSTAL CODE:TELEPHONE:

SHIPPING ADDRESS IF DIFFERENT:

HOLSTER MODELS:

COLOR:

RIGHT OR LEFT HAND:*Left Hand Add $15.00 To Total

NEUTRAL CANT/FORWARD CANT/CROSSDRAW:* If applicable

SPECIAL INSTRUCTION/DETAILS:

WEAPON MANUFACTURER:MODEL:

REVOLVER OR AUTO:CALIBER:

BARREL LENGTH:

SUB TOTAL:

DOMESTIC SHIPPING:(Add $13.95 up to 2 small holsters. Add $22.95 up to 2 medium size holsters. We ship all domestic orders Priority U.S. MAIL)

SUB TOTAL:

SALES TAX:NYS RESIDENTS MUST ADD SALES TAX

TOTAL: