Evaluation Application Form

ORGANIZATION TYPE

Military	Law Enforcement	Government Facility	Training Facility
Paintball Store	Paintball Field	Paintball Team	Private Group

CONTACT/SHIPPING INFORMATION
Contact Name: ___________________________________________________________________
Company/Organization: ____________________________________________________________
Address: ________________________________________________________________________
City: __________________________________ State: __________ Zip Code: ________________
Phone: ________________________________ Fax: _____________________________________
Email: __________________________________________________________________________

EVALUATION UNIT INFORMATION (Select package for evaluation)

T16 (M4 .43 Caliber) -- MSRP $699.00

T68 (M4 .68 Caliber) -- MSRP $699.00

CREDIT CARD  INFORMATION (For insurance)
Name:_____________________________________________________________________________ Address:____________________________________________________________________________
City:__________________________________________ State:___________ Zip Code:_____________

Credit Card # __________________________________ CCV#: __________ (3 digits on back of card)
Expiration Date: _____________  Customer Service Phone Number:____________________________
Credit Card Type: [  ] Master Card  [  ] Visa [  ] Discover [  ] American Express

I, _____________________________________________________, agree that the sample unit I request above is sent to me by Real Action Paintball LLC for evaluation purpose only, for an evaluation period of 30 days since the day I sign this application.  I agree to return the unit in similar condition that I receive, within the evaluation period.  I agree to pay a shipping and handling fee of $30.00 for each demo unit within USA.  My credit card will be billed at the MSRP price at the time the demo is shipped. If the unit is not returned within the evaluation period, I agree that the full amount of the unit's retail price plus tax (8.25% for California tax, not applicable to other states) will be charged to my credit card above.  Also, if the unit is not returned in the similar condition as I receive, the cost of damage will be assessed and charged to my credit card above. In the event that this charge is contested by myself or charged back to Real Action Paintball LLC, I agree that I am responsible for any charges incurred by Real Action Paintball in defending authorization.  In the event that a refund is due, all monies owed will be credited back to this credit card.

Signature: ______________________________________________      Date: ____________________

Printed name: ___________________________________________      Date: ____________________