USPSA Certified Ammunition Manufacturers Declaration

USPSA Certified Ammunition Manufacturers Declaration
Date of Declaration*

MonthDayYear
Date
Company Name*
The Official Brand Name for your Ammunition
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Website*
For publication on USPSA Web Page
How will customers purchase your ammunition?*
Web Store, Retail Outlet, Telephone order, etc.
Web Store Address
For publication on USPSA Web Page
Retail Outlets
Contact Person*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
ATF License*

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Please upload a .pdf copy of your ATF License Cancelof
Federal Tax ID#*
How much ammunition of each SKU or caliber and bullet weight below did you produce in the 12 months prior to making this declaration?*

250,000 - 500,000 rounds500,000-1,000,000 roundsMore than 1,000,000 rounds

Please list the products you wish to qualify for USPSA Certified Ammunition*

Please upload a summary of your testing procedures for Quality Control, Velocity, Bullet Weight, and how you track results, i.e., Lot number, Batch number, Random sample number, etc.*

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How will this ammunition be distributed?*

Direct Shipment to MatchRetail OutletBoth
I certify that the information provided is accurate, the loads submitted achieve the declared USPSA Power Factor, the ammunition is available for sale to the general public, and I agree to adhere to the USPSA Certified Ammunition Policy*

Clear
Signature
Please type the name of the person signing above*