Customer Order Form

NOTE: Please add $1 postage per pin ordered

Please print out and send with your order
   
Belt Mountain Enterprises
Box 353
Belgrade, MT. 59714
Fax 1-406-388-1396
   
Date: _____________

Customer Name: _______________________________

Address: _____________________________________
(U.S. Mail)

City: _______________________________

State: ____________ Zip: ______________

Phone #: Home ________________

Phone # Work ________________


Type of gun: ________________ ( Blackhawk, Vaquero, Bisley, Single Six, Colt,
    Super Blackhawk)

Caliber ____________________

Type of Pin: Standard, Standard Locking, Knurled Locking, # 5 w/Allen screw, Sheriff's Model, Ruger Colt-style, #5 w/Bowen pin

Blue: _________ or Stainless: ___________

New Model: ________________________

Old Model, with or without transfer bar safety? __________________

Method of Payment: ______________________________________

If Using MasterCard or Visa, expiration date: ____________________

Thank you for your order!