*Today's Date ex:  mm-dd-yyyy
*Name of applicant
*Date of Birth ex:  mm-dd-yyyy
*Street Address
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Comments:

My email address is
(include entire email address, ex: myemail @ myprovider.net)

NOTE:

• If this is your first purchase permit, you will be required to take a test before getting your permit.

• You MUST show a picture identification, showing your current address, when picking up your permit.

• You MUST be a resident of Van Buren County to obtain a permit.

• The purchase permit is good for 10 days from the date of entry.

Call 269-657-2006, x-224 if you wish to check on the status of your permit.