eSales, Inc.
8550 West Charleston Blvd., Suite 102-124
Las Vegas, NV. 89117
Date of Birth:
Fax:
E-Mail:
Drivers License #:
Telephone:
City, State,Zip:
Address:
Name:
Fill out this form completely. Print, then sign the form and fax or mail it back to us.
 
Fax To: 1-716-549-0809 or Mail it To:
I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct.
 
Signature____________________________________________________    Date______________
 
No locksmithing devices will be sent with out identifying an category and a signature.
 
A motor vehicle manufacturer
A lock manufacturer
A motor vehicle dealer
A bona fide repossessor
A lock distributor
A bona fide locksmith
CERTIFICATION TO RECEIVE LOCKSMITHING TOOLS
 
The undersigned hereby certifies that
he/she/it is eligible, pursuant to 39 USC 30 Sec. 3002a to receive locksmithing devices though the mail.
 
The undersigned certifies that they are eligible because he/she/it is:
 
 
(check one or more)
Lock Picks Authorization Form