Membership Application

General information

Name:  SSN:  DOB:  

Address:  City: 

State:  Zip Code:  Home Phone: 

Cell Phone:   Email: 

Place of Employment (Optional):  Title (Optional): 


Driver License #:   State:  Expires: 

Concealed Weapons Permit #:  Expires: 

Please send all correspondence to (Check One): 



I understand that the Lawmen’s & Shooters’ Supply, Inc. offer of Membership is contingent upon the receipt and evaluation of a background check report.  I am providing Lawmen’s & Shooters’ Supply, Inc. with my social security number and date of birth to permit a background check to occur.  Failure to provide consent, or the required information, will result in the withdrawal of my application for Membership.  If my application for Membership is accepted, Lawmen’s & Shooters’ Supply, Inc. may request such additional reports or information about me for member related purposes during the course of my Membership.  I understand that if my application for Membership is accepted, my consent below, will apply throughout my Membership to the extent permitted by law.  I further understand that my continued Membership is contingent on a satisfactory background check report, and I consent to such background checks on an annual basis.


I have carefully read and understand that this Background Check Consent Statement and, by my signature below, consent to the release of (among other information) criminal history and sex offender registry reports to Lawmen’s & Shooters’ Supply, Inc. within the terms of this Statement.  This Background Check Consent Statement in original, faxed, photocopied, or electronic form will be valid for any such reports that Lawmen’s & Shooters’ Supply, Inc. may request.


(Office Use Only)  Membership #: __________________________________________

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Lawmen's and Shooters' Supply Inc.
Signature Certificate
Document name: Membership Application
lock iconUnique Document ID: 404cfabf7b66bb49773c825f84ae59442f621aa9
Timestamp Audit
September 11, 2020 1:42 PM EDTMembership Application Uploaded by Lawmens Memberships - IP
September 11, 2020 1:45 PM EDTLawmens Memberships - added by Shaun Jensen - as a CC'd Recipient Ip:
September 11, 2020 2:02 PM EDTLawmens Memberships - added by Lawmens Memberships - as a CC'd Recipient Ip: