Les Baer Order Form

All complete firearms and receivers must be ordered through an FFL-licensed dealer.

To order items, either (1 ) print out this form, fill it out, and either fax or mail it to Les Baer Custom Inc or (2) fill out this form online and send it via email to Les Baer Custom Inc.

1804 Iowa Drive | LeClaire, IA 52753

Phone (563) 289-2126 | FAX (563) 289-2132

info@lesbaer.com

Please enter the following information:
Name
Address (Shipping)
Address (Billing)
City, State, Zip
Phone
Email is a required field. Your order will not be processed without a valid email address.
Email
ORDERS SHIPPED UPS, please include street address as box number is insufticient. PRICES ARE SUBJECT TO CHANGE WITHOUT NOTICE.

For each item, enter: Quantity, Description, Unit Price, and Total:
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6

To calculate total remittance, add the ''Totals" together, add shipping charges, and enter here:
Total remittance:

Method Of Payment:
Please remit total by one of the following methods:

1. Sending your valid Visa or MC information on this form:
Type of Card
Card Number
Expiration Date

2. For Credit Card and RUSH ORDERS ONLY please call (563) 289-2126. FAX (563) 289-2132. (To speed your call, fill out your order form). Please include card type and expiration date.

3. Mailing printed orderform and a personal check or postal money order (U.S. funds please) to:
	Les Baer Custom, Inc. 1804 Iowa Drive LeClaire, IA 52753

Comments:

Method Of Payment:

Thank you for ordering from Les Baer Custom, Inc.