usndcmd.org - USNDC Marine Detachment Association

USNDC Commemorative Shotgun

Remington Model 870

ORDER FORM page 1

Name _______________________

Street Address________________
_

City__________________________

State/Zip ______________________

Phone Number _________________

Driver’s License #________________State ______

USNDC Association Membership # ________(required)

(to join USNDC Assoc. see website USNDCMD.org)

Name to be engraved (print exactly) ______________________________________

Shotguns must be shipped to a FFL dealer (gun shop)

 Dealer information:

Name ________________________

Street Address _________________

City __________________________

State/Zip ______________________

Phone Number _________________

(we will contact your dealer for shipment and FFL information)

Enclose a money order of cashier’s check for $550.00 made out to “Mike Boyington”  

(no personal checks or credit cards accepted)

Mail this completed form and check to:

Mike Boyington                     

958 Back Brooks Rd

Monroe, ME  04951                        (Go to page 2)