HomeMy WebLinkAboutFire Department Lock Box
THE DAMA CO.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
I PL:ASE READ
ORDERING INFORMATION:
r 'H I PPED SEP 2 " 2006
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 65% 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
SHIP TO: (DO NOT USE A P.O. BOX)
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Address~~ W. (t3rJt~T.
City/St/Zip "''?LS . MAJ. 6543B
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ORDERED BY: DATE: ~tuf-1L~
Company ~-r ~?
Address~~ W.1B~SL-
City/St/Zip 1Y.\'~~~~5 I dlAJ ~~
Name & Ph # ~,,~ . . 3'~
FIRE DEPARTMENT INFORMATION
NAME:
PRIOR LAKE FIRE DEPT.
. SIGNATURE
S D WITHOUT
E
INSTAllATION ADDRESS :r:SJ> 1 \,
- REOUIRED BY FIRE DEPT. 17$G
- ATTACH LIST IF MORE ROOM IS NEEDED
4540 =ro~~ S~~ S. 6.',
P(L\oL lAtc..6 r h1/\l STIT?
ORDER FORM - Payment must be submitted with order
ITEM
S2-SURFACE MOUNT (NO MTG KIT OfJTION AVAILABI_E)
S3-SURFACE MOUNT
S3-SURFACE MOUNT W/TAMPER SWITCHES
R3-HECESSED MOUNT
R3-f~ECESSED MOUNT wrr AMPER SWITCH
MOUNTING KIT (OPTIONAL FOFi S-3 & R-3 MODELS 0
OTY
PRICE
$ 107.00
$131.00
$168.00
$160.00
$18600
$ 59.00
SUB TOTAL 10
SHIPPING & PROCESSING Cf--lG. $900
SUB TOTAL WITH SHIPPING CHG.
MINNESOTA SALES TAX, 6.5%
MAIL TO:
DAMA-MP INC.
PO. BOX 47824
PLYMOUTH, MINN.
55447
DARRYL SUNDBERG
763-559-3660
6/.>1J':rr. .$o(fb~T
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