Retail Firearms Supplemental Application GENERAL INFORMATIONBusiness Name Effective Date MM slash DD slash YYYY Website Current Carrier InformationCarrier Limit of Insurance Deductible Premium Offering renewal? Yes No Claims made? Yes No Please attach copies of the followingCurrently valued five year loss runs, including claim detail for all losses open or exceeding $15,000 Drop files here or Select files Max. file size: 512 MB. Product brochure, catalog, or marketing materials if a website is not available Drop files here or Select files Max. file size: 512 MB. A copy of all Federal Firearms Licenses (FFLs) held by you Drop files here or Select files Max. file size: 512 MB. What are your operations? Check all that apply Firearms, Suppressors, and Lower Receivers Manufacturing Operational Firearms Parts and Holsters Manufacturing Non-operational Firearms Parts Manufacturing Gumsmithing/Gun Repair (on customer supplied arms only) Accessories and Optics Manufacturing Ammunition Manufacturing Wholesale Firearm Distribution or Military/LEO only Retail Sales Retail Civilian Firearm Sales Body Armor/Ballistic Paneling Manufacturing Firearm Range Manufacturing Paintball Marker Manufacturing Pellet, BB, and Airsoft Gun Manufacturing Manufacturing of “gray” parts (unbored/80% receivers, cheek paddles, trigger cranks Other Explain operations Please complete the below table regarding your salesUpcoming Year (est.):Last 12 Months:One Year Prior:Two Years Prior:Three Years Prior: Add RemoveIf more than one box in (What are your operations?) is checked, please clarify what percentage of sales is in each categoryDo you have any sales outside of the US, US Territories, and Canada? Yes No Are foreign sales insured elsewhere? Yes No Audit/Inspection contact Phone numberEmail If selling any airsoft/airgun or bb/pellet gun, do all products bear a brightly colored safety tip? Yes No Please provide maximum FPS for most powerful unit If selling any ammunition, are any products of an atypical or specialty nature such as incendiary rounds, armor-piercing bullets, or rubber, bean bag, or pepper less-than-lethal? Yes No Please list For retail firearm sales, please clarify the followingIs a formal Straw Sales policy in place? Yes No Are all employees required to sign off on these policies, regardless Yes No of full or part time status? Yes No Have you or any of your employees ever been cited for a Straw Sales violation? Yes No Please attach details of the event and steps taken after Drop files here or Select files Max. file size: 512 MB. Do you have a mandatory waiting period? Yes No Does this apply to all firearms or only specific types? Please listPlease describe the security measures in place at your location(s):If you are selling products online, do you require a dealer address and FFL to ship? Yes No Have any products manufactured, distributed, or sold by you been involved in a mass shooting event? Yes No Please provide detailsFor ballistic paneling other than plates and vests, are products tested by an independent 3rd party? Yes No Please clarify to what NIJ level products are tested toDo you sell any less-than-lethal weaponry? Yes No Please list and clarify if sales are to Military/LEO, civilian, or bothHave you ever been cited for an ATF violation? Yes No Was your FFL suspended or revoked? Yes No Please attach a copy of the ATF warning letter, any follow up letters, and details of steps taken to ensure that violations of this nature will not occur in the future. Drop files here or Select files Max. file size: 512 MB. Are batch or product records, serial numbers or copies of guarantee/warranty cards maintained that would facilitate tracing whereabouts of products? Yes No Confirm how long these records are maintainedIn the event that it becomes necessary to recall a product, do you have a recall plan in place? Yes No Do you have Product Recall insurance? Yes No What means would be used to secure the return and disposal of the product?Have you ever had a product recall event? Yes No HiddenSection BreakDate of recall(s) MM slash DD slash YYYY Type of recall(s) Voluntary? Ordered? By what agency? Product(s) involvedReason for recall and how discovered What was the remedy of the problem? What percentage of recalled goods were returned/repaired? HiddenSection BreakAre there any present situations that might give rise to an incident causing a product recall? Yes No Supply detailsHave you had any Product Liability claims that were or were not covered by insurance? Yes No Please provide detailsDuring the past five years, has any insurer ever canceled or non-renewed similar insurance to any applicant or has your insurance been canceled for nonpayment of premium by any insurance or finance company. Yes No Please explainIs your company aware of any occurrences, facts, circumstances, incidents, situations, damages or accidents (including but not limited to allegations of faulty or defective products, product failure, product dispute bodily injury or property damage) arising out of or related to your products that a reasonably prudent person might expect to give rise to a claim or lawsuit whether valid or not which might directly or indirectly involve the company? Yes No Applicant Title FEIN # Date MM slash DD slash YYYY
