USPSA Certified Ammunition Manufacturers Declaration

USPSA Certified Ammunition Manufacturers Declaration
Date of Declaration

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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?

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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Cancelof
How will this ammunition be distributed?
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

Signature
Please type the name of the person signing above