AFFIDAVIT FOR MAIL ORDER AMMO

Directions:
Use your browser's print option and print this page for a quick mail in age verification.

(Please Do Not Fax this form to us , PleaseEmail or mail it  to us with a copy of your photo id)

Mail To:
SCHARCH MFG INC.
10325 COUNTY ROAD 120
SALIDA, CO 81201
PHONE:1-800-836-4683

** NOTE **
IT IS FEDERAL LAW THAT PURCHASERS MUST:

BE 18 YEARS OLD TO BUY LONG GUN AMMUNITION

BE 21 YEARS OLD TO BUY HANDGUN AMMUNITION. (INCLUDES RIMFIRE)

GIVING THE DEALER FALSE INFORMATION COULD RESULT IN A $5000 FINE, 5 YEARS IMPRISONMENT, OR BOTH.

PLEASE SIGN BELOW IF YOU INTEND TO BUY AMMUNITION.I HAVE READ THIS NOTICE AND AM OF LEGAL AGE, AND AM NOT
VIOLATING ANY FEDERAL, STATE OR LOCAL LAWS BY MAKING PURCHASES.

E-MAIL (Optional): ____________________________________

PRINT NAME: _______________________________________

DATE OF BIRTH: ________________

DRIVER'S LICENSE NUMBER ______________________________

AND STATE ISSUED: _______________________

SIGNATURE: _____________________________________ DATE: ___________