Installation Order Form
Poly-Choke
322 N Military Rd
Fond du Lac, WI 54935
Toll Free: 1-866-609-5874
Phone: 920-929-0667
Fax: 920-929-0670
Date:_______________
Company Name:___________________________________
First Name:_______________ Last Name:______________
Address:__________________________________________
City:_____________________ State:______ Zip:_________
Phone Number:____________________________________
PLEASE INSTALL:
___
Ventilated Choke
#900001 Gun Brand _________________
___
Standard Choke
#900002 Gun Model# _________________
___
Ventilated Rib
#900020 Gun Gauge __________________
___
International Rib
(top only) Straight or Taper change POI higher or lower
___ Custom Rib ______ Height Taper Y N _____Width Taper
Y N Ramp Length ____
___ Adjustable Comb ____ Recoil Reducer ___ Graco ___
R.A.D.
For rib installation, complete gun is needed to insure
alignment of barrel and receiver.
OVERALL FINISHED DESIRED LENGTH:
_____________
Inches choke install only
Please Note: if overall length is not specified,
barrel will be finished to same overall length as received.
**Barrels With a Ventilated Rib:
Please indicate whether customer will accept
the length longer or
shorter of desired length. We must back up to closest
rib support post. **Longer / Shorter (circle one)**
For choke installation, we only need your barrel shipped
if we have an action for your gun. Popular guns
we have are Remington models 11, 1100, 1148, 17, 58,
870, 1187; Winchester models 12, 40, 50, 59, 97, 1200,
1300, 1400, SuperX-1, Ithaca model 37, Browning models
A-5, Double Auto, 2000, and others. Please
call to confirm or we will need complete gun to test
fire.
COLOR OF FRONT SITE:
___ Gold
___ Ivory
___ Red
___ Sunspot (orange)
___ Fiber Optic orange only for ribbed barrel
___ Fiber Optic green only for ribbed barrel
VENTILATED RIB INSTALLATION:
COLOR OF MID RIB BEAD:
___ Gold
___ Ivory
___ Silver
Postage
: All
shipments are F.O.B. Fond du Lac, WI 54935.
Please add Shipping and Handling
Charge of
$20.00 for single barrel, $25.00 for complete gun.
Alaska and Hawaii, add $25.00 for
single barrel and
$30.00 for complete gun.
Note: Non-take-down barrel, extra $25.00.
Payment by check or credit card. Check made out to:
Poly-Choke
Credit card transactions will be done over the telephone to insure
security.
