AMMOMAN.COM PRINTABLE FAX FORM
Use your mouse and keyboard to fill out the information on your order then click file/print on your browser,
Then just FAX it in and use the printout for your records, NOTE: Netscape may not work or look correct when printing
This is not a SUBMIT FORM so nothing is e-mailed to anyone

Discount Distributors
1036 Industrial Drive
West Berlin, NJ 08091

Shop Phone:
( 856 ) 767- 8835 E.S.T.

Fax:
( 856 ) 753-3383

 E-mail:
eric@ammoman.com

ITEMS BEING ORDERED:

Quantity

 Item Price Total

SUB TOTAL:

TAX ( If applicable )

Credit Card users DO NOT ADD 3%

XXXXXX

FREE SHIPPING

XXXXXX

TOTAL

PAYMENTSHIPPING / BILLING INFORMATION:
If shipping address is same as billing you can leave this area blank

Billing Address Shipping Address
Name:       Name:
Address:       Address:
City:       City:
State: Zip:       State: Zip:
Phone:       Phone:
Fax:       Fax:
Email:       Email:

PAYMENT INFORMATION:

Paying by:

If using a Credit Card:

Name on CARD: Expiration Date:
CARD #:   3-DIGIT CODE ON THE BACK #:

I CERTIFY THAT I AM OVER 21 AND THERE ARE NO STATE, FEDERAL OR LOCAL LAWS THAT PROHIBIT ME FROM PURCHASING AMMUNITION

Your Signature X_________________________________________________

Now click File/Print on your browser !