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THE DAMA CO.
FIRE DEPARTMENT
'KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
I P~EASE READ
, O~DERING 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 SHIPPED AUS 1 6 2011
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 C. rHl.. {\( (2.. ' :,( \) 1\ y dv( A ~ lvf\(\ { (n.V.
Address 1-10\ Er1\T L{l;Yl ~~-.t.
City/St/Zip C \'\I'f:>,^"(~ fY'(). s s ~ 11'6
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Attention of: k' (ll.J \ll Av' ~
--------------------
ORDERED BY: DATE: f'; ( I 0 I O~
Company c::::A~\JC~::..--c:~"OI\ EI) ~'\-'
Address 2o';~o.r.." LP'~l.:oFCA2.) WA<.-r
City/St/Zip \c-<::.\'A(-...l IiVIN <:; S;':;-2.
PRIOR LAKE FIRE DEPT.
AUTHORIZED FIRE DEPT. SIGNATURE
ORDERS.WILL NOT BE P CESSED WITHOUT
AUTHOO/I~p FP!I/~N UR, E
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Name & Ph # ,. AI..J l.. I rz-A \i I;' '1 52 ;3~B - ~S !.
INSTA~LATIONADDRESS srR-/ GLA~c-AIZ.-
- REQUIRED BY FIRE DEPT. LiA,ZN !NG C6I'J,EI'"
- ATTACH LIST IF MORE ROOM IS NEEDED L"l ()IA
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ORDER FORM - Payment must be submitted with order
MAIL TO:
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAILABLE) $ 107.00
S3-SURFACE MOUNT , $131.00 J?,/w
S3-SURFACE MOUNT WrrAMPER SWITCHES $168.00
R3-RECESSED MOUNT $ 160.00
R3-RECESSED MOUNT WrrAMPER SWITCH $186.00
MOUNTIN~. KIT (OPTIONAL FOR S-3 & R-3 MODEL~:,\Y) JJ n _ $ 59.00
~.rOTAL -,U, p, I 0()
SHIPPING & PROCESSING CHG. $9.00
SUB TOTAL WITH SHIPPING CHG. I Lf 0 .'('KJ i
MINNESOTA SALES TAX, 6.5% -
TOTAL AMOUNT ENCLOSED J W n. on
ITEM
aTY
PRICE
TOTAL
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH, MINN.
55447
DARRYL SUNDBERG
763-559-3660
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