Contact Information

*Name:
*Email:
Company Name:
*Phone Number:
*Address:
*City:
*State:
*Zip:
* Required fields.

IMPORTANT: (Read and Complete the Following) This merchandise is sold and shipped upon the presentation by the buyer that the same will be used strictly in accordance with the laws of the state of destination. Make yourself aware of your state laws, and follow them. This merchandise is sold upon the condition that the seller shall not be liable for any arrest, accident, or injury occasioned during the transportation, handling, storage, sale or use of the merchandise. You are aware of the dangers of fireworks and willing to assume full responsibility for using these products. You specifically agree that you will not sue the seller or any agent of the seller for any claims that may arise from the use, storage, transportation, or resale of the seller's products. This release is executed freely and voluntarily by you for the purpose of protecting the seller from future potential liability. You understand and acknowledge the significance and consequence of such specific intention to release any and all future claims against the seller. We refuse to sell fireworks to anyone under the legal age of 18. You understand that Kellner’s Fireworks will not be responsible for any loss of merchandise due to any legal violation once fireworks leave our warehouse. This form is good for multiple transactions in the year 2009.  

Website Design:
Rossow Futuristics