Law Enforcement Sale Restriction - Defense Spray & Chemical Agents

Chemical agents in certain sizes, formulations and/OR delivery systems are restricted to law enforcement purchase only and 
are not sold to the general public 

In order to ship restricted items to individual (non-agency) purchasers, we require authentication of peace officer affiliation with a law enforcement or government agency. The form below can be used to furnish such authentication. 

To proceed, print this form with your browser's print feature. Fill out the information and include a photocopy of employment ID. Then Fax it or e-mail it to us. Once received, this information is subject to verification and securely filed for future purchases of such restricted items.  

No restricted product will be shipped until this information is received. All submitted information is considered confidential and will not be released in any way.

CopQuest Order No.: ________________________________
Your Name: ________________________________ Date: ______________
Agency/Employer: ________________________________ Badge/ID No.: ______________
 Address: ________________________________ Telephone: ______________
City, ST, Zip: ________________________________ Fax: ______________
Items to be Purchased: __________________________________________________
__________________________________________________

I certify that I am authorized to purchase and possess items as described above.

Signature: _________________________________________________________

Photocopy of Front 
of agency/employment 
Identification card here

(attach additional page if ID does not fit here)

Photocopy of Back
 of agency/employment 
Identification card here

(attach additional page if ID does not fit here)

Fax this form to: 805-388-0771 or E-mail to: id@copquest.com
Or mail to: CopQuest Order Administration · 365 Camino Carillo · Camarillo, CA 93012