Date: _____________


If this is your FIRST order with The Maine Powder House, you must sign the statement below and fax, email or mail to The Maine Powder House along with a COPY OF YOUR DRIVERS LICENSE before your order will be shipped. If your signature and drivers license is already on file with The Maine Powder House your order will be shipped as soon as payment is cleared.

I, _________________________, certify that I am at least 21 years of age and that I am a legal citizen of the United States of America. I intend to use this purchase of Black Powder from The Maine Powder House solely for sporting, recreational or cultural purposes in black powder firearms. I have read and understand the ordering policy and product disclaimer.


Signature ____________________________


Email to jr@mainepowderhouse.com
 
Fax to 1-800-701-9061 ( enlarge and lighten license )
 
Or Mail to The Maine Powder House, Inc.
P.O. Box 5
Peru, ME 04290
207-562-7499