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Firearm Registration Refusal Form
Business Name
Business Address
Contact Number
Email Address
Federal Firearm Lic. #
Rejected Buyer Name
Date of Birth
January, 2019
January, 2019
S
M
T
W
T
F
S
53
30
31
1
2
3
4
5
2
6
7
8
9
10
11
12
3
13
14
15
16
17
18
19
4
20
21
22
23
24
25
26
5
27
28
29
30
31
1
2
6
3
4
5
6
7
8
9
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