To order:   Make one form out for each SET of grips
 Send in your grips , or buy a new set of   grips from me.  
ORDER FORM FOR THE  "GRIPS" ONLY,      PERSONAL CHECKS TAKE 5 WORKING DAYS TO CLEAR. .          MAKE OUT  CHECKS OR MONEY ORDERS TO Made out to: [ Jim Burgess  ]                    
     J.M.B. DISTRIBUTION                            {$50.00 is for engraving BOTH  side of the grips }
     4291 VALLEY QUAIL S.                                    
     WESTERVILLE , OHIO 43081-3810 
              614-891-5784  res. calls 7-9 pm est.               
 
  YOUR E MAIL ADDRESS HERE: ---

YOUR NAME AND ADDRESS:                                                           

 


ENGRAVE ALIAS AS:


 

LOGO:  =    [ COLT  ]   [ RUGER ]   [TAURUS]     [BERETTA]     [S&W]   ENGRAVE MY "ALIAS" 

CIRCLE CHOICES:                              [  Block] or [Script ] lettering

NO EXTRA CHARGE

PICK ONE OF MY DESIGNS      ex. right grip=  "cowboy_horse"                        
      
RIGHT GRIP =

 $ 50.00
 Cost covers both grip sides.

LEFT GRIP =                                                  
                                                                     

                                                                         

 
 

CUSTOM GRIP "your design"  [ enclose design w/ order ]

 $ 60.00
 

BUY MY  GRIPS       see "GRIPS"  page for prices  [GRIP # here____________]

 $

shipping and handling        [next day delivery enclose the correct amount]

 $  7.00 per  BOX

 OHIO RES . ADD 6% SALES TAX

 $

    SW76 cd    shows live firing and the suppressor                                                                                           

 $ 5.00

    Make checks out to :Jim Burgess TOTAL