BAGONNJ Permit Form

Black American Gun Owners Network

Firearm Purchase Permit Form
Do you have a CLEAN criminal background, mental health history, and a valid NJ ID?*

YesNo (if no, DO NOT finish form & contact bagonnj@gmail.com)
Full Name (Add middle name if initial is on your ID)*

First NameMiddle NameLast NameSuffix
Gender*

FemaleMale
Race*
Height*
Weight*
Hair*
Eyes*
Distinct Physical Features*
Tattoos, Prominent Birthmarks Ect.. If no write NONE
Birth Date*

MonthDayYear
City, State, Of Birth*
City, State, Country
Social Security Number*
Drivers License Number*
State Drivers License Issued*
U.S. Citizen?*
Employer Name*
Employer Address*
Employer Phone
Job Title*
Your Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
County Of Residence
Does your name & address match your ID?*

YesNo (if no, finish form & contact bagonnj@gmail.com)
Home Phone*
Cell Phone*
E-mail*
example@example.com
References

Two References who have known you for a minimum of 3 Years
Reference 1 Name*

First NameLast Name
Reference 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 1 Email*
example@example.com
Reference 1 Phone*
Please enter a valid phone number.
Reference 2 Name*

First NameLast Name
Reference 2 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2 Email*
example@example.com
Reference 2 Phone*
Please enter a valid phone number.
All Info Entered Is Correct and matching your ID?*

Yes info is accurate
Additional comments *
Add maiden name, or addresses lived in past 10 years.. if none write none
Add 2 Additional References, SBI Number, Make, Model, Caliber, and Serial Number of Handgun. (Carry References Can NOT Be Related To You)
**THIS SECTION IS FOR CARRY PERMIT APPLICANTS ONLY**
Upload a passport style photo against a light colored background. (see sample below)*

Cancelof
Criminal Background

If no criminal history click no for all, if yes give a brief explaination.
Have you ever been convicted of any domestic violence offense in any jurisdiction which involved the elements of(1) striking, kicking, shoving, or (2)purposely or attempting to or knowingly or recklessly causing bodily injury, or (3)negligently causing bodily injury to another with a deadly weapon?*

NoIf Yes Explain Briefly
Are you subject to any court order issued pursuant to Domestic Violence?*

NoIf Yes Explain Briefly
Have you ever been adjudged a juvenile delinquent?*

NoIf Yes Explain Briefly
Have you ever been convicted of a disorderly persons offense in New Jersey or any criminal offense in another jurisdiction where you could have been sentenced up to six months in jail that has not been expunged or sealed?*

NoIf Yes Explain Briefly
Have you ever been convicted of a crime in New Jersey or a criminal offense in another jurisdiction where you could have been sentenced to more than six months in jail that has not been expunged or sealed?*

NoIf Yes Explain Briefly
Do you suffer from a physical defect or disease?*

NoIf Yes Explain Briefly
Are you an alcoholic?*

NoIf Yes Explain Briefly
Have you ever been confined or committed to a mental institution or hospital for treatment or observation of a mental or psychiatric condition on a temporary , interim, or permanent basis?*

NoIf Yes Explain Briefly
Are you dependent upon the use of a narcotic(s) or other controlled dangerous substance(s)?*

NoIf Yes Explain Briefly
Have you ever been attended, treated, or observed by any doctor or psychiatrist or at any hospital or mental institution on an inpatient or outpatient basis for any mental or psychiatric condition?*

NoIf Yes Explain Briefly
Have you ever had a firearms purchaser identification card, permit to purchase a handgun or any other firearms license or application refused or revoked in New Jersey or any other state?*

NoIf Yes Explain Briefly
Are you presently, or have you ever been a member of any organization which advocates or approves the commission of acts of force and violence, either to overthrow the Government of the United States or which seeks to deny others their rights under the Constitution of United States or the State of New Jersey?*

NoIf Yes Explain Briefly
SEND PAYMENT OF $150 VIA ONE OF THE PAYMENT METHODS BELOW $300 FOR CARRY PERMIT QUALIFICATIONS.

CLICK HERE FOR CASHAPP ................ $bagonnj

CLICK HERE FOR VENMO ................... @bagonnj

For ZELLE send payment to ............... bagonnj@gmail.com
AFTER SUBMITTING:

CLICK HERE TO VIEW A SHORT GUN SAFETY AWARENESS SLIDE
As a valued customer, we want to ensure your private information is kept private and only shared with those companies who are authorized by you.
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Black American Gun Owners Network

References

Criminal Background