Order Form

Name _________________________________________________________________

Address _______________________________________________________________

City_____________________ State ____________ Zip Code ___________________

Phone ____________________________________________

Email address___________________________________________________________

Bill and Ship To address the same- Yes_______ No________

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

Stag
Ivory Max
Other___________________________

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

 

FINISH (mark all that apply)
Stainless. High Polish
Stainless. Vapor Honed

Black Chromex. High Polish
Black Chromex. Vapor Honed Satin Black

Fire Blue Parts

Color Case Harden

Two-toned. Specify below:

Special Engraving. Special engraving, such as group logos, special badges, presentation wording, or any pictures or drawings you would like engraved on the gun, generally $150 per scene or drawing. List special engraving below or include your artwork with your order.

 

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  ________________________________________________________________________ DEBIT / CREDIT (circle one)
expiration date _______________ 3-digit code ___ ___ ___

We try to deliver your custom gun in the time frame listed on our website. Still, due to shortages or backorders from various suppliers, such as those for materials used for grip, steel suppliers, and engraving template providers, over which we have no control, we may occasionally exceed the expected time period. We hope you will understand this and be flexible. If you need to have the gun by a specific date for a hunt or special event, please notify us at the time of your order, and we will do our best to accommodate it. Any order cancelled will be subject to a 20% penalty plus payment for any templates or engraving stencils.

For liability reasons, any parts replaced during a firearm conversion cannot be returned.

Your Signature ______________________________ Date ________________

 

Any post-order changes must be made in writing.