TASER® Order Form          
Full Name:
Ship to Address:
Address 2nd line (if needed):
City, State, Zip:
Home Phone:
Daytime Phone (if different):
E-mail Address (optional):
Ever Convicted of a Felony:   (Yes or No)
Driver's License Number:
License Expires on:
License State:
Date of Birth:
Social Security #:
Name as it appears on credit card:
Credit card address (if different):
City, State, Zip (if different):
MC, VISA, American Express or Discover:
Credit Card Number:
Expiration date:
3 Digit Bank Number on back:
Item(s) you wish to order:
         
         
         
         
Total $ Amount:

         Credit Card Orders Only Mail to: Internet Company, 8628 Canyon View Dr, Las Vegas, NV 89117.

         Driver's License, Date of Birth and Social Security Number are required for M18 and M18L purchases.
         The C2 background check is done after receipt at a charge of $9.95, and an activation code is issued.