Company Name*:

Contact Name*:

Position*:

Address*:

City*:

State/Province*:

Zip/Postal Code*:

Country*:

Phone*:

Fax:

Email*:

Date Purchased*:

Company Purchased From*:

Package Purchased*:

Serial Number(s)
- List the serial number for each Shocknife*:

(for the Single pack fill in the first Serial # and leave other spaces blank)

(for the Knife Fighter fill in the first 2 Serial #'s and leave other spaces blank)

(for the Academy Package fill in all 10.)

Note: *denotes required information.