HomeMy WebLinkAboutFire Department Key Lock Box
THE DA~ 10.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
I PL:ASE READ
ORDERING INFORMATION:
1) This order must be signed with the signature of the
authorized Fire Department official on file with the DAMA CO.
2) The key box will be shipped to you without any keys and will
be locked in the open position. Contact your local Fire
Department for specific mounting requirements.
3) Please include 6.5% Minnesota sales tax and shipping charge.
4) Full payment must accompany order. Make check payable to THE DAMA CO.
5) Allow 1-2 weeks for delivery.
CUSTOMER INFORMATION
FIRE DEPARTMENT INFORMATION
NAME:
SHIP TO:
(DO NOT USE A P.O. BOX)
Company
Address
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PRiOR U\KE FmE DEPl
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AUTHORIZED FIRE DEPT. SIGNATURE
ORDERS ,W)LL;r Nft ~E P~~ES~D WJTHOUT
AUTHO~lzi~'FP SIGNAT FE!. _ _
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,- ORDERED BY:
DATE:
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Address ?) ~5 <:.:; C; v.) -7,'..1::/+: (::'r
City/St/Zipl)l....w, IN'.;> r 01"-. 1 r\L~ L., ~4 ~):i
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Name & Ph #. i:;.;. I2F '~ i'-.- L. t;- v A ,..J f)'{ s' 2 . Z" ~~,I ' <;"~(:'::;;
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- ATTACI-f LIST IF MORE ROOM IS NEEDED
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ORDER FORM - Payment must be submitted with order
ITEM
QTY
PRICE
TOTAL
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE) $107.00
S3-SURFACE MOUNT $131.00
S3.SURFACE MOUNT '4J~ER SWITCHES $168.00
R3-RECESSED MOUNl1 f , i i ... _. $160.00 rr-~: 2 0 00
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R3-RECESSED MOUNr wrr AM PER SWITSHf $186.00
MOUNTING KIT (OPTIONAL FOR S-3 & R-3 MODELS ONLY) $ 59.00
SUB TOTAL rt'~2u u(:
SHIPPING & PROCESSING CHG. $9.00
SUB TOTAL WITH SHIPPING CHG. ? ) Cf ()
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MINNESOTA SALES TAX, 6.5% 1 1 ~ '1
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TOTAL AMOUNT ENCLOSED Ii '. - ::;1
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White & Yellow Copy - DAMA CO.
Pink Copy - Customer
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MAIL TO:
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH. MINN.
55447
DARRYL SUNDBERG
763-559-3660