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Firearm Registration Refusal Form
Business Name
*
Business Address
*
Contact Number
*
Email Address
invalid email address
*
Federal Firearm Lic. #
*
Rejected Buyer Name
*
Date of Birth
September 2025
September 2025
S
M
T
W
T
F
S
36
31
1
2
3
4
5
6
37
7
8
9
10
11
12
13
38
14
15
16
17
18
19
20
39
21
22
23
24
25
26
27
40
28
29
30
1
2
3
4
41
5
6
7
8
9
10
11
*
Race
Please select
Asian
Black
Hispanic
Middle Easterner/Arabic
Native American
Other
Pacific Islander
Unknown
White
*
Sex
Please select
Male
Female
*
Driver's Lic. #
*
Address
*
Make of Firearm
*
Model of Firearm
*
Caliber of Firearm
*
Submitting Employee
*