TASER® Weapon Order Form
1-800-352-5294 702-341-1620 Print this form
Name:______________________________________________________________
Address:___________________________________________________________
City:____________________________ State:______ Zip:________________
Phone:______________________ Email:______________________(Optional)
Driver's license #:______________________________________(Required)
State:_____ Expiration date:_________ Convicted of Felony? ______
Ship to if different:______________________________________________
Address:___________________________________________________________
City:____________________________ State:______ Zip:________________
Qty Description Total
___ TASER® C2 Small Non-gun Personal Weapon in Designer Colors @ TBD ______
___ TASER® Weapon M18L w/ 4 Cartridges, Laser Sight & Case @ $599.95 ______
___ TASER® Weapon M18 Weapon with 2 Cartridges and Case @ $399.95 ______
___ Free w/ TASER® Weapon - Shoulder Holster left/righthand ($89.95) ______
___ Set of 2 TASER® Air Cartridges for all TASER® Weapons @ $60.00 ______
___ Other items:__________________________________________ ______
Shipping: Add $4.55 per item (TASER® Weapons ship free): ______
Total charge: ______
____Visa ____MasterCard ___Check ___Money Order
Card Number:______________________________ Expiration Date:________
Fax to: 702-341-1652 or Mail to:
Internet Company
8628 Canyon View Drive
Las Vegas, NV 89117