TASER® Weapon Order Form       1-800-352-5294   702-341-1620   Print this form

Name:______________________________________________________________

Address:___________________________________________________________

City:____________________________ State:______ Zip:________________

Phone:______________________ Email:______________________(Optional)

Driver's license #:______________________________________(Required)

State:_____  Expiration date:_________  Convicted of Felony? ______

Ship to if different:______________________________________________

Address:___________________________________________________________

City:____________________________ State:______ Zip:________________

Qty  Description                                              Total

___  TASER® C2 Small Non-gun Personal Weapon in Designer Colors @ TBD ______

___  TASER® Weapon M18L w/ 4 Cartridges, Laser Sight & Case @ $599.95 ______

___  TASER® Weapon M18 Weapon with 2 Cartridges and Case @ $399.95    ______

___  Free w/ TASER® Weapon - Shoulder Holster left/righthand ($89.95) ______

___  Set of 2 TASER® Air Cartridges for all TASER® Weapons @ $60.00   ______

___  Other items:__________________________________________   ______

     Shipping: Add $4.55 per item (TASER® Weapons ship free):  ______

                                               Total charge:  ______

____Visa   ____MasterCard     ___Check   ___Money Order

Card Number:______________________________  Expiration Date:________

Fax to: 702-341-1652 or Mail to: 
                                  Internet Company
                                  8628 Canyon View Drive
                                  Las Vegas, NV 89117