GUN RACK ORDER FORM To ensure the correct product is built/shipped, please complete the following form and send it to Pro-gard Products. This form must be completed with every order for a gun rack. If this form is not completed your order may be delayed. This form is for distributor use only. The Distributor is responsible for the information provided and must provide signature upon completion. Thank you for your cooperation.

PART 1 PART 2

Distributor:______Vehicle Make:______

Purchase Order:______Model:______Year:______

Contact Name:______Partition in vehicle: Yes_____ No _____

Phone Number:______If Yes which manufacturer and type:

Email:______

PART 3 Mark 1st Firearm With: F1 Mark 2nd Firearm With: F2 PART 4 Pump Semi Automatic Shotguns Tactical Select key type: ___ Remington 870 Police Magnum ___ 1301 Tactical ___ (AR-15 Style) Platform ___ Handcuff Key ___ Remington 870 Express/Wingmaster ___ Tactical ___ A1 Triangle M16 ___ Vending Machine (Barrel) Key ___ Mossburg 500 / 590 ___ Remington 1187 ___ A2 Round / C7 __5 __6 __8 Shot ___ M4 / C8 ___ Straight Key ___ Benelli Nova * If weapon is not listed, please ___ Short Barrel AR * If no key type is selected our ___ Benelli Super Nova attach/send photo of weapon ___ ___ H&K - Model:______standard handcuff key will be with this form sent by default ___ Ruger Mini 14

PART 5 PART 6 What accessories does the weapon have? Select Gun Rack: ($100.00 List Price Up-charge per Universal Lock Addition)

F1 F2 ____ G4906 Series, Single Vertical Retro-fit ______Ghost Ring Sights ______Heat Shield ____ G5000 Series, Flat Surface Mount ______Side Saddle ____ GPC Series, Pro-cell Vertical Mount ______Carry Handle ____ GVM Series, Vertical Self-Supporting Mount ______Vertical Foregrip ____ GVPM Series, Vertical Partition Mount ______Sight/Scope ____ GMM Series, Motorcycle Mount Brand:______GTM Series, Sedan Trunk Mount Model:______

Location:______

______Light *(Photo Of Gun Required) PART 7 Signature Required: Brand:______Agency/Company Name: ______Model:______Date: ______Location:______Print Name: ______You may also circle the location of the accessories you have on photos below: Signature:______NOTE: Pro-gard Products requires at least three inches to lock around the forearm.

Firearm 1 (F1) Firearm 2 (F2) 800.480.6680 | www.pro-gard.com