Name* First Last Billing Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Return Ship Address* Same as Billing address (if not, un-check this box to fill in return shipping address) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zipcode Model* Serial number on receiver* I am sending in:* Complete shotgun (if not, select options below) Barrel Fore-end Stock Receiver Barrel 1 Gauge12ga20ga28ga.410gaBarrel 1 Length26"28"30"32"34"Barrel 1 Serial No. Barrel 2 GaugeNot Applicable12ga20ga28ga.410gaBarrel 2 LengthNot Applicable26"28"30"32"34"Barrel 2 Serial No. Barrel 3 GaugeNot Applicable12ga20ga28ga.410gaBarrel 3 LengthNot Applicable26"28"30"32"34"Barrel 3 Serial No. Did you purchase the gun New or Used?* New Gun Used Gun Retailer name where gun was purchased?* Retailer Name Date of purchase* MM slash DD slash YYYY Enter the approximate date if unsure of the exact dateHave you submitted the Warranty Registration for this gun?* Yes, this gun has been registered No, it was not registered Rounds Fired* Less than 2,500 (specify number) Between 2,500 & 5,000 Between 5,000 & 10,000 More than 10,000 (specify number) Specify number (if requested)* Detailed description of services requested including customizations, additions or issues you are experiencing*I understand* There will be a minimum charge of $195 to perform an inspection & diagnosis on all guns that are no longer covered under warranty. Parts and shipping are not included. Caesar Guerini USA 700 Lake Street Cambridge, MD 21613 Phone: 410-901-1131 Stay Connected On: Caesar Guerini USA Business Hours: Monday – Friday 9AM to 6PM EST