PRINT AND FAX (561) 265-4520 OR MAIL THE FOLLOWING STATEMENT TO US:
Century International Arms, Inc.
430 South Congress Ave.
Suite 1
Delray Beach, FL 33445

Release, assumption of risk, and waiver of liability agreement.
By purchasing any item from Century International Arms, Inc., whether by mail or in person, the buyer warrants that he has checked and verified that he is in compliance with all federal, state and local laws, and is legally able to purchase these items. For ammunition purposes, I further certify that I am an adult over 18 years of age (if purchasing handgun ammunition, I certify that I am over 21 years of age) and under no legal disabilities.
Please mail or fax a copy of your I.D.

Name:_________________________________________________

Complete Address: _________________________________________________

Phone: _________________________________________________

Date of Birth:______________________________________________

Signature:________________________________________________

*Please note: It is the policy of Century International Arms, Inc. not to ship ammunition to non-immigrant aliens in the United States because Century International Arms, Inc. is unable to verify their status in the United States for the purpose of purchasing Ammunition. -121201-