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ColtsManufacturingCo.

2TalcottRoadWestHartford,CT06110
Contact:MarkRedlEmail:MRedl@colt.comPhoneNumber:(860)2441345

Test&EvaluationForm
SubmittedBy: DateofRequest:
Email: PhoneNumber:

Model(s)Requested:
Publication:
ArticleDueDate:
PurposeofArticle:

WriterBillingAddress:
City,State,Zip:
CreditCard: Visa,MasterCardorDiscover(CircleOne)
Choose One
CardNumber: ExpDate:
*PleaseIncludeaCopyoftheCurrentFFLforTransfer*
FFLName:
Phone#:
Address: State: Zip:

Submitthefollowingrequeststo:MarkRedl,ProductManager,MRedl@colt.com
*UpdatedProcessasof10/01/2016*
Test&Evaluation:FilloutthisformandsubmittoColtforapproval.Uponapproval,wewillcontactyouandgivean
estimatedshipdate.OncetheproductisshippedtotheFFLyouhaveprovidedwewillnotifyyou.Itisyour
responsibilitytoseethatthefirearmislegallytransferredtoyouinandthatyourpossessionofthefirearmis
consistentwithallapplicablelaws.
*ALLLOANSAREFORA90DAYPERIODUNLESSOTHERWISENOTED*
Attheendofthe90dayperiod,youhavetheoptiontopurchasethefirearmorreturnthefirearmtoColt.
ToPurchase:Thisloanwillshipwith90dayterms.After90days,youaregiventheopportunitytopurchaseatthe
discountedpricegivenattimeofshipment.
ToReturn:RequestaFedExcalltagfromColt.ThecalltagwillbeemailedtoyouItisyourresponsiblytoreturnthe
firearmthroughtheoriginalFFLthefirearmwasshippedto.Beforeshippingthefirearm,readandfollowthe
proceduredescribedintheColtinstructionmanual.Donotshipafirearmwitharoundinthechamberoronwhich
theserialnumbercannotberead.
IcertifythatIhavereadtheinformationaboveandprovidedallcurrentinformationrequested.
Signature: Date:
ForOfficeUseOnly:
ApprovalSignature: Date:
SalesOrder: ShipDate:
SerialNumber: CallTag:

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