Black Powder Release Form

Black Powder Release Form
TRAVELERS ANTIQUES AND TRADING

100 DUNCAN STREET CLAUDE TEXAS 79019
806-679-9016

806-470-4130

THE FOLLOWING STATEMENT MUST BE ON FILE FOR EACH PURCHASER BEFORE TRAVELERS ANTIQUES AND TRADING WILL SHIP ANY ORDER.

STATEMENT OF RELEASE AND CERTIFICATION

I.I CERTIFY THAT I AM AT LEAST 21 YEARS OF AGE.

II.I CERTIFY THAT ALL BLACK POWDER I PURCHASE IS SOLEY INTENDED FOR SPORTING, RECREATIONAL,OR CULTUTRAL PURPOSES FOR USE IN ANTIQUE FIREARMS OR DEVICES.

III.I CERTIFY THAT I AM NOT PURCHASING BLACK POWDER FOR RESALE.

IV.I CERTIFY THAT NO FEDERAL, LOCAL, OR STATE ORDINANCES PROHIBIT MY PURCHASING OR POSSESSING BLACK POWDER.

IT IS AGREED THAT THE PURCHASER NAMED BELOW SHALL HOLD TRAVELERS ANTIQUES AND TRADING HARMLESS AND INDEMNIFY IT AGAINST EACH AND EVERY LOSS; CAUSE OF ACTION SUIT ON ACCOUNT OF PURCHASER; OR DAMAGES TO OR LOSS OF PROPERTY OR ANY THIRD PERSON GROWING OUT OF PURCHASER'S OPERATIONS AND OR ACTIONS UNDER THIS AGREEMENT OR OTHERWISE.
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