2601 E. 7th Ave.
Flagstaff, AZ 86004

Telephone: (928) 527-4100  Fax: (928)527-0840


Order Form
Print this page - Fill it out completely and mail in with your payment


Name _________________________________________________________________

Address _______________________________________________________________

City_____________________  State ____________  Zip Code ___________________

Phone ____________________________________________

Custom Series requested (i.e. El Diablo) ____________________________________  (if no series, "custom Ruger")

Caliber ________________________   Barrel Length  - Octagonal________________   Round__________________

Sights (mark one)
Standard Ramp with white outline rear
Gold bead or Red Fiber Optic or Green Fiber Optic with V rear (circle one)

Free Wheel cylinder (circle one)  YES   NO                                                                                                                                Special Features (list here)

GRIP STYLE (mark one)                                                                                                                           
Birdshead (Tombstone Classic Style)
Gunfighter Grip
Gambler's Grip (Doc Holliday Style)
Standard Factory


GRIPS (mark one)
Laminated Walnut, Cherry, or Ironwood
Ivory Max

Do you want your name or cowboy handle engraved on the gun?  If so, print it below:


Heavy Duty base pin? (cylinder pin)  We use Belt Mountain  - (mark one) - YES   NO    

FINISH (mark one)
Stainless. High Polish
Stainless. Vapor Honed
Black Chromex. High Polish
Black Chromex. Vapor Honed Satin Black
Two-toned.  Specify below:

Special Engraving. Special engraving such as group logos, special badges, presentation wording, or any pictures or drawings you need engraved on the gun add $150 per scene or drawing.  Show special engraving below or enclose your logos etc. Please list special engravings below.........



Porting or Muzzle Brake  
Magnaport $300   (mark one) - YES  NO
Muzzle Brake $300  (mark one) - YES  NO

To be built on your gun?  (mark one) - YES   NO   If on your gun, list the
serial number _____________________________

Deposit _______________________________

Credit Card Number (if applicable) ________________________________________________________________________   DEBIT / CREDIT (circle one)
expiration date _______________ 3-digit code ___ ___ ___

We try to deliver your custom gun in the time frame listed on our web site, but due to shortages or backorders from various suppliers such as grip makers, steel suppliers, engraving templates and many others upon which we have no control, we may from time to time go over the expected time period. We hope you will understand this and be flexible. If you have to have the gun by a certain date for a hunt or special event make sure and let us know at the time of the order. Any order cancelled will be subject to a 10% penalty and payment for any templates or engraving stencils.

Due to liability, the inner parts of your gun replaced during a conversion cannot be returned.


Your Signature ______________________________   Date ________________


Any post- order changes must be made in writing.