HANDGUN SAFETY CERTIFICATE PROGRAM SUPPLY ORDER FORM by jry13335

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									                                      CALIFORNIA DEPARTMENT OF JUSTICE
                           HANDGUN SAFETY CERTIFICATE PROGRAM
                                                    SUPPLY ORDER FORM
            Note: Orders on any priced items must be accompanied by a check or money order made payable to Department of Justice.

                    ITEM                         PRICE                           QUANTITY                     TOTAL COST
         HSC Certificate Set of 10*          $150.00 per set              (sets only)                         $
         HSC English and Spanish
         Language Video                         $5.00 each                                                    $
         HSC Study Guide                                                                                      $
         (English Language)                    $ .50 each


         HSC Written Test Set*                                                                                    no charge
         (English Language)                       no charge
         HSC Written Test Set*
         (Spanish Language)
                                                  no charge                                                       no charge
         HSC Numeric Roster*                      no charge                                                       no charge
         Safe Handgun Demonstration                                                                               no charge
         Affadavit                                no charge
         Certified Instructor Manual              no charge                                                       no charge

         Other

      * Item may be ordered only by DOJ Certified Instructors.                                TOTAL =        $

DOJ Certified Instructor
or Firearms Dealers Licensee Name
                                                           Last                           First                         Middle

Certified Instructor #                                        and/or California Firearms Dealer #


Physical (Shipping) Address                                                                  Day Phone # (          )
                                                         Street


               City                                                     State                                            Zip Code

Mailing Address (if different)
                                                                        Street


                 City                                                    State                                            Zip Code




                                 Signature                                                                   Date


                                                                                                          DOJ Use Only
   Mail To:         California Department of Justice
                    Bureau of Firearms, HSC                                                       Date Received _______________
                    P.O. Box 981118
                    West Sacramento, CA 95798-1118                                                Date Processed _____________
BOF 038 (revised 7/2009)

								
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