To place an order, simply print off this page and fill in the information. Mail to the address on
the form along with payment by check or money order payable to D. Jeffrey. When we receive
your order, it will be signed and dated and a copy returned to you for confirmation of receipt.
It will also include an approximate completion date.
If you have any questions, feel free to E-Mail me at jeffreyleather@yahoo.com or call 918
306-2406. Thank you for your business.           Jeff
Jeffrey Custom Leather  3505 S. Riverside  Yale, OK. 74085
                                                         www.jeffreycustomleather.com
Customer Name_________________________________________________________
Address________________________________________________________________
City___________________________________State__________Zip_______________
Phone_________________________E-Mail___________________________________
QTY.     Item              Rt./Left      Color    Gun Make      Model            Cal.     Barrel Length    Price
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Note: Belt slots and loops on concealment holsters are cut for 1.5 inch gunbelts unless otherwise requested.
Extra Features / Special Instructions: ______________________________________
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                            Sub Total:__________________
Okla. Residents add 5.313% tax:_______________
                             Shipping:____________
$12.00
    ******Make checks payable to D. Jeffrey
                 TOTAL Enclosed:_________________
Customers Signature:__________________________________Date:____________
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Custom leather holsters are built meticulously by hand and go through many stages of construction,
treating and curring. It is a slow process that does not lend itself to mass production. We feel the extra steps
are worth it and we hope you will agree when you receive your new holster. We strive to keep orders on
schedule and appreciate your patience. We do not take lightly, the confidence that you have placed in us
and will do our best to exceed your expectations.
Payment received on:_______________by_______________________________
                                                                                                            ( Authorized agent of Jeffrey Custom Leather )
Estimated delivery date:______________________________
Liability: The end user is solely responsible for the use of this product and accepts all liability for its use.
Your signature acknowledges that you have read the safety warnings elsewhere on this web site.