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.

Les Baer Custom
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
Calculate the amount of your purchases by adding the above totals and entering that amount here:
Total cost of merchandise:
(Note: LBC will calculate the shipping charges for your order and add that amount to your final invoice total.)

Method Of Payment:
Please remit total by one of the following methods:
We only accept VISA or Mastercard There will be a 2% processing fee on any Credit Card purchase over $100. 1. Sending your valid Visa or MC information on this form:
Type of Card
Card Number
Security Code
Expiration Date
2. 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:
Submit

Thank you for ordering from Les Baer Custom, Inc.