Ruger Records Department / 1 Lacey Place / Southport, Connecticut 06890

R E Q U E S T

F O R

L E T T E R

O F

A U T H E N T I C I T Y

To receive your Ruger Letter(s) of Authenticity, complete the form below and mail a personal check

or money order for $10.00 per letter to:

Ruger Records Department / 1 Lacey Place / Southport, Connecticut 06890

P E R S O N A L I N F O R M AT I O N :

Name:

Address:

Phone:

City

State

REQUEST #1:

REQUEST #2:

F I R E A R M I N F O R M AT I O N :

F I R E A R M I N F O R M AT I O N :

Firearm Type:

Rifle

Pistol

Revolver

Shotgun

Firearm Type:

Rifle

Pistol

Model Marked on Firearm (if any):

Model Marked on Firearm (if any):

Serial Number:

Serial Number:

Caliber:

Caliber:

$10.00 Payment Included

REQUEST #4:

F I R E A R M I N F O R M AT I O N :

F I R E A R M I N F O R M AT I O N :

Rifle

Pistol

Revolver

Shotgun

Firearm Type:

Rifle

Pistol

Model Marked on Firearm (if any):

Model Marked on Firearm (if any):

Serial Number:

Serial Number:

Caliber:

Caliber:

$10.00 Payment Included

REQUEST #6:

F I R E A R M I N F O R M AT I O N :

F I R E A R M I N F O R M AT I O N :

Rifle

Pistol

Revolver

Shotgun

Firearm Type:

Rifle

Pistol

Model Marked on Firearm (if any):

Model Marked on Firearm (if any):

Serial Number:

Serial Number:

Caliber:

Caliber:

$10.00 Payment Included

Shotgun

Revolver

Shotgun

Revolver

Shotgun

$10.00 Payment Included

REQUEST #5:

Firearm Type:

Revolver

$10.00 Payment Included

REQUEST #3:

Firearm Type:

Zip

$10.00 Payment Included

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