When Completed, Mail Form To:

Dean Rumbaugh, Company Historian
1605 Commerce Way
Paso Robles, CA 93446

Weatherby Authenticity Order Form

Name:_______________________________________________________

Address:_____________________________________________________

City/State/Zip:_________________________________________________

Phone: (Home) ___________________ (Work) _____________________

Fax #: ______________________________________

Card #: _____ - _____ - _____ - _____ Expiration Date: __________

Serial #: _____________________

Model: _____________________

Caliber/Gauge: __________________

Barrel Length: _____________________
(measure from muzzle to center of receiver ring)

Description of Stock/Metal finish:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Additional Comments:

__________________________________________________________________

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OFFICIAL OFFICE USE ONLY: