HomeMy WebLinkAboutFire 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 SHIPPED MAR 2 8 2087.
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.
~) Allow 1-2 weeks for delivery. _ "
CUSTOMER INFORMATION
SHIP TO: (DO NOT USE A P.O. BOX)
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Company.L c:-0iScH DN'S-;-;l.Iki"fU.....J.....".
Address 3(bSL~~1C..1 Avo':
City/St/Zip fJt'Lv fr-- AG-u'; ^~ ~ &::",(r,{, 71
Attention of: N( \ ~(~ ~ t H E= I ~I
ORDEREDB~---DAT~~~~1---
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Company t:;..J .,' 'X:.. (4) (_....Cn..........,~11... C'IV''''
Ad dress -;, I "'"' L.~y'l..- '1 ~...e.
CitY/St/Zip~M~. AI ')c...u-' \
Name & Ph #M!~t c;'-H~<I.) 0Iz~{$)-./4S()
FIRE DEPARTMENT INFORMATION
NAME:
PRiOR LAKE ffRE OEPT
INSTALLA ESS
- REQUIRED BY FI~PT.
- ATTACH LIST IF MORE ROOM IS NEEDED \,
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4lA (0 (J<"'O~ AD 0 St.. -PiZ~ ~.::/{!.. .. J\AJ~
PiZl<.-/L LA~~. CO MAl '-":-~"3.7,,-
ORDER FORM - Payment must be submitted with order
ITEM
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE)
S3-SURFACE MOUNT
S3-SURFACE MOUNT wrr AMPER SWITCHES
R3-RECESSED MOUNT
R3-RECESSED MOUNT WrrAMPER SWITCH
MOUNTING KIT (OPTION1\Lf1'0. S-3 & R-~M
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QTY
PRICE
$ 107.00
$131.00
$168.00
$160.00
$186.00
$ 59.00
TOTAL
IPPING & PROCESSING CHG.
SUB TOTAL WITH SHIPPING CHG.
MINNESOTA SALES TAX, 6.5%
TOTAL AMOUNT ENCLOSED
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MAIL TO:
TOTAL
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH, MINN.
55447
i (c,Q
DARRYL SUNDBERG
763-559-3660
; (PC) -
$9.00
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