Order Form
Mail to:
Lonnie Ingram
PO Box 597
Batavia, Oh 45103-0597
Please include this form with payment for orders or sending parts to be machined. If you
are sending more than one set indicate quantities.
Name:________________________________________________________________
Address:_______________________________________________________________
City:__________________________________ State:________Zipcode____________
Phone:________________________________
Email:_________________________________
I have enclosed the following parts to be machined:
____ lock Frame
____ Action Arms
_____ Feed Block
_____ Barrel
I would like to order:
_____ Semi Conversion kit
_____ Fuzee Rivets
I
Mail to:
Lonnie Ingram
PO Box 597
Batavia, Oh 45103-0597
Please include this form with payment for orders or sending parts to be machined. If you
are sending more than one set indicate quantities.
Name:________________________________________________________________
Address:_______________________________________________________________
City:__________________________________ State:________Zipcode____________
Phone:________________________________
Email:_________________________________
I have enclosed the following parts to be machined:
____ lock Frame
____ Action Arms
_____ Feed Block
_____ Barrel
I would like to order:
_____ Semi Conversion kit
_____ Fuzee Rivets
I