Cibola Sportsman’s Club

License and Stamp Fax Order Form

(Please use one form per individual)

Fax form to (928) 857-0091

or e-mail to info@hunt4geese.com

Click the Back Button on your Browser to Return to CSC Web Site

Select a License:

 

     Non-Resident 3-Day Hunt ($64.25) – Valid for three calendar days

 

     Non-Resident Annual Hunt ($154.25) – Valid 1-1-04 through 12-31-04

 

     Non-Resident Annual Hunt & Fish ($228.25) – Valid 1-1-04 through 12-31-04

 

     Youth License – Under 21 ($29.50) – Valid 1-1-04 through 12-31-04

 

     Resident Annual Hunt ($36.25) – Valid 1-1-04 through 12-31-04

 

     Resident Annual Hunt & Fish ($57.00) – Valid 1-1-04 through 12-31-04

 

Select a Stamp:

 

     Migratory Bird Stamp ($4.50)

 

     Arizona Waterfowl Stamp ($8.75)

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The information collected by the Cibola Sportsman’s Club, Inc.  to prepare your license and/or stamps shall NOT be disclosed except as required by state and federal law. All credit card numbers are being treated as confidential information for the purpose of processing your order only. The prices above include processing and shipping fees.

Please complete:

 

Last Name:_________________________ First Name:__________________________ M.I.________

 

Street Address:____________________________City:___________________State:___ Zip_______

 

Sex:      M       F  Weight: ____ Height:______

 

Color Eyes: ________ Color Hair:_________ Date of Birth: _____________Today’s Date_________

 

If purchasing a 3-day Non-Resident license enter dates valid:

 

Valid from: ____ - ____ - ______ Valid through: _____ - _____ - ______

                     mm     dd        yy                                 mm       dd          yy

 

Payment Info:

 

Credit Card: (Circle One)    VISA    MasterCard   American Express

 

Card Number: ________________________ Name (as written on Card_______________________

 

Exp. Date: _______________  Zip Code:_____________ Telephone # ________________________

 

Shipping Info:

 

Shipping Method (Circle One):  1.) Mail to Address Above  2.) Pickup on Date of Hunt: _________

 

Please Return by fax to (928) 857-0091

Or Mail Order form with your check to Route 2, Box 105 Cibola, AZ 85328

For Questions regarding your order please call (760) 921-1100.