Directions:
Use your browser's print option and
print this page for a quick mail in age verification.
(PLEASE DO NOT FAX THIS FORM TO
US.)
Mail To:
THE AMMO BANK
PO BOX 24103
ROCHESTER, NY 14624-0103
PHONE: 800-357-9757
AFFIDAVIT FOR MAIL ORDER AMMO
** NOTE **
IT IS FEDERAL LAW THAT PURCHASERS MUST:
BE 18 YEARS OLD TO BUY LONG GUN AMMUNITION
BE 21 YEARS OLD TO BUY HANDGUN AMMUNITION. (INCLUDES RIMFIRE)
GIVING THE DEALER FALSE INFORMATION COULD RESULT IN A $5000 FINE, 5 YEARS IMPRISONMENT, OR BOTH.
PLEASE SIGN BELOW IF YOU INTEND TO BUY AMMUNITION.
I HAVE READ THIS NOTICE AND AM OF LEGAL AGE, AND AM NOT
VIOLATING ANY FEDERAL, STATE OR LOCAL LAWS BY MAKING PURCHASES.
E-MAIL (Optional): ____________________________________
PRINT NAME: _______________________________________
DATE OF BIRTH: ________________
SIGNATURE: _____________________________________ DATE: ___________
DRIVER'S LICENSE NUMBER ______________________________
AND STATE ISSUED: _______________________