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 Shotguns Semi Automatic Shotguns Tactical Rifle Select key type: ___ Remington 870 Police Magnum ___ Beretta 1301 Tactical ___ (AR-15 Style) Platform ___ Handcuff Key ___ Remington 870 Express/Wingmaster ___ Benelli M4 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 ___ Beretta Cx4 Storm ___ 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.