NMDOH Gun Violence Prevention

Gun Lock Request Form

Please complete the fields with the full and complete corresponding information. We cannot ship gun locks outside of the state of New Mexico. All information you provide will NOT be sold or distributed to any third party vendor or listserv.


Any questions may be sent to Alexander Cutler, Gun Violence Prevention Program Coordinator, at alexander.cutler@doh.nm.gov.

 

Please enter today's date.

 
mm/dd/yyyy
 

Gun Lock Request

Please complete the fields with the full and complete corresponding information below.

 

ie: are you ordering the lock for yourself, as an individual? Or is this request for a bulk order on behalf of an organization?

 

 

Person Submitting Request: