Contact & Billing Information

First Name *

Last Name *

Email Address *

Phone Number *

Billing Street Address *

Apartment, Suite, Unit (Optional)

City *

State *

ZIP Code *

2

Shipping & FFL Transfer Details

Transfer at Cybex Precision Gunworx (Toledo, OH) — $25 FFL transfer fee

Receiving FFL Dealer Name (If ordering a firearm)

FFL Phone / Email / License # (Optional if sending later)

Shipping address is the same as billing address

Order Notes (Optional)

3

256-bit SSL encrypted credit card processing via Accept.blue.

Card Number *

Expiration Date (MM/YY) *

Security Code (CVV) *