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 keystonemissy@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.
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.