| Firearm Serial #: |
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| First Name: |
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| Last Name: |
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| Return Address: |
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(Full street address, NO PO BOX!) |
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(Additional apt/suite # or other extra info) |
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| City: |
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| State: |
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| Zip Code: |
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(ex: 12345, 123456789, 12345-6789) |
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| Phone: |
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| Email: |
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| Description: |
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Please describe the issue you are |
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experiencing with your firearm's |
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Dura-Touch coating (2000 chars max) |
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