USER EXPERIENCE
ELEY Ammunition
Customer Name
*
First Name
Last Name
Customer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Telephone Number
*
Date & Time of Submission
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Brand of ELEY Ammunition
*
Batch Number 1 (Located at the end of the box)
*
Batch Number 2 (Located at the end of the box)
Batch Number 3 (Located at the end of the box)
QTY of Rounds Purchased
*
QTY of Rounds affected
*
QTY of Rounds Remaining
*
Firearm Manufacturer
*
Firearm Model
*
Dealer Name
*
Dealer Location
*
Ammunition Purchase Date
*
-
Month
-
Day
Year
Date
Details
*
Provide Photos if relevant
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Customer Signature
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After clicking submit, you will be contacted within three (3) working days. Thank you for your patience.
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