William Larkin Moore and Company

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					SHOTGUN ORDER FORM Please print and mail with payment, or fax. DATE: ______________________ NUMBER:___________________
ORDER FROM: NAME: ADDRESS: PHONE:		_____________________ _____________________ _____________________ _____________________	SHIP TO: NAME: ADDRESS: PHONE:			_____________________ _____________________ _____________________ _____________________
	CUSTOM ORDER FOR: __________________________________________________________ MAKE: _______________________ MODEL: ________________________ GAUGE: ________ BARRELS: 1st Set: Length: ___________ Chamber: __________ Chokes: Rt./U ___________ Lt./O ___________ 2nd Set: Length: ___________ Chamber: __________ Chokes: Rt./U ___________ Lt./O ___________ TOP RIB: Smooth Concave ______ Matted Concave ______ Level Filecut ______ Solid ______ Ventilated ______ ACTION: Finish: Casecolor ____________________ Coin _________________ Triggers: Double _____________ Single ____________ Single Selective ___________ Safety: Automatic _______________ Non-Automatic _____________ Extra Springs & Pins __________ Locks: Detachable _________________ Slotted Screws _____________ Other __________________
STOCK & FOREARM: Type of Stock ______________________ Type of Forearm ____________________ Type of Stock Finish _________________ Type of Butt _______________________ Type of Checkering __________________ Wood Upgrade _____________________ Stock Oval ________________________				STOCK DIMENSIONS: Right/Left Hand Shooter ________________ Drop @ Comb _______________________ Drop @ Heel _______________________ Length of Pull ________________________ Cast @ Heel _________ @ Toe _________ Pitch _______________________________ Gold Crest __________________________
Desired Weight: _______ Trunk Case: Maker Furnished & Labled ________ Other ______________ ADDITIONAL COMMENTS: ____________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________