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)* Combination of any and all locks on your gun case (if no locks please enter N/A)* Detailed description of services requested including customizations, additions or issues you are experiencing*I approve* I approve charges up to $200. We will thoroughly examine all mechanical parts for any wear or damage and replace if needed. Parts that need to be replaced due to normal wear and tear or customer alteration are not covered under warranty. This will help ensure continued proper functioning of your gun for future use. Charges could be less than $200. If they exceed this amount, we will call for approval. 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