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Statement of Eligibility form




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When purchasing ammunition from Keystone Arms, Inc., you must complete this form and send along with a copy of your Drivers License and either email to sales@keystonearms.com or mail to: Keystone Arms, Inc., 4 Pennsylvania Avenue, Matamoras, PA  18336

STATEMENT OF ELIGIBILITY

TO PURCHASE AMMUNITION

(Non-FFL Holders Only)

 

 

 

I CERTIFY that I am not prohibited by Federal, State or Local laws to purchase, own or possess the ammunition ordered.

I further certify that I am at least 21 years of age and am a US Citizen.

 

 

 

AN ENLARGED COPY OF YOUR CURRENT DRIVER’S LICENSE IS REQUIRED

Must be sent via US Mail – Faxed copies will not be accepted.

 

 

 

 

__________________________________                _______________________                          Signature                                                                    Date

 

 

__________________________________                _______________________                          Printed Name                                                             Phone Number

 

 

NOTE:  LAW PROHIBITS the purchase of ammunition by minors,

drug addicts, convicted felons, illegal aliens, those convicted of a misdemeanor crime of domestic violence or the mentally ill.