Duffys' Gun Broker Auction Winner Payment Form  

                   Auction  #______________________Price_________

                   Auction  # ______________________Price_________

                       Auction  # ______________________Price_________

                                                                      Total _________

                                         Shipping and Insurance   __________ 

                                 3% Credit Card Fee (of all above)   _________

                                                                    Grand Total__________         

      Type of Card ________ 

      Card#_________-__________-__________-__________

      Exp Date _______/_______            Security Code ______  

       Name_____________________________________________

       Billing Address________________________________________ 

      _____________________________________________________

     _____________________________________________________

                    Phone Number  _________________________________

       Shipping Address  (If different from Billing Address)  

         __________________________________________________

       _____________________________________                                     

         ___________________________________________________

Name of FFL ____________________________________________