M & R Specialties
1126 S. Gratiot Ave.
Mt. Clemens, MI 48043
(586) 954-3998
Date: ___________________
Customer Name: ___________________________________________
Street Address: _____________________________________________
City: _____________________________
State: ___________________
Zip Code: ____________________
E-Mail Address ___________________________________
Daytime Phone: Area Code _________ Phone:_______________
Firearm Manufacturer: _____________________________________
Serial#________________________
Caliber:_________________ Model: __________________________
Finish Desired :________________________________________________
( ) Rings & Bases ( ) Muzzle Brake ( ) Extra
Mags ____________
Special Instructions:____________________________________
Payment Policy: We accept only money orders, personal checks, or cashier's checks for work provided. Shipping costs are determined when work is completed and may be paid with a money order, personal check, or cashier's check.)
Payment Type: ( ) Money Order ( ) Cashier's Check ( ) Personal Check
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