order form

PBI Internal Use Only FSC SF
Date Received
Job/Inventory #

Name:_______________________________________________________

Address:_______________________________________________________

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Phone #'s:______________________________________________________

Email:_________________________________________________________

List item(s) included with detailed instructions & serial numbers (if applicable):

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Ship All Orders & Make Check / Money Order Payable To:
Para Bellum Inc.
6916 Heavrin Ave
Louisville, KY 40218
(502)759-4010

Total Check or Money Order Payment Enclosed:

$

List CC # Below:

____________________________________

Exp. Date: _________________________

- OR -

If you wish to pay by CC over the phone, please indicate so by checking the box below & someone will contact you for your info.

Call Me For Payment