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Test Drive Application
Personal
Data
Name
(Last, First, Middle)___________________________________
Date of Application ___/___/___
Social
Security Number
- -
Birthdate___/___/___
# of Dependants/Ages___________
Mailing
Address______________________ City______________
State_____ Zip_____
Years____
Physical
Address_____________________ City_____________ State_____
Zip_____ Years_____
Home
Phone (
)____________________ Work Phone
( )_______________________
Email Address
_____________________________________________________
Home
Rent_______
Own________
Drivers License Number-State__________________________
Have
you ever declared Bankruptcy?________
Had a repossession?______________
Judgment?_____
Explain_______________________________________________________________________
Employment
Employer____________________________________________
Years at this Company_________
Address____________________________________ City______________ State____ Zip_______
Phone
( )______________ Title_________________
Salary/Wages (Gross)________
Previous
Employer____________________ Years
at this Company______________
Address____________________________________ City______________ State____
Zip_______
Model for
Test Drive
Krieghoff
(circle):
K-80 KX-5
K-32 or
Kolar
Model: Skeet
Trap Sporting
Barrel
Length (circle): 28"
30" 32"
34"
Chokes
Tubes (circle): Yes
No
Stock
(circle): Skeet
Trap Sporting
Stock
(circle): Adjustable
Yes No
Length
of Pull: Standard
Custom___________________
Referral
Please
send a Krieghoff Catalog to:
Name_______________
Address____________________ City____________
State____ Zip______
Name_______________
Address___________________ City____________
State____ Zip______
| I
certify that the statements herein are true and that I am
not liable for any debts, other than specifically listed.
Europa Corporation, d.b.a duPONT/KRIEGHOFF is authorized
to obtain any information which it deems necessary for consideration
for the test drive request. If approved.
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Signature
of Applicant__________________________________________
Date____/____/____
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