HomeMy WebLinkAboutFire Department Key Lock Box
THE DAMA CO.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
r:
I P~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
SHIP TO:
(DO NOT USE A P.O. BOX)
L <; R
Company
Address
City/St/Zip
Attention of:
.1-- - - - _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ __
ORDERED BY: DA TE:
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Company L 7 {( ~tJd.\.(/ /{;~.~.
Address
{(.; '1 b.l. '1'/i1J.~\V z:.
{i..'vr~~ /)Jtn. 5"5'337
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9~J- ~~J.- Iff;). V
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City/St/Zip
Name & Ph # ''11 c-
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FIRE DEPARTMENT INFORMATION
NAME:
pnlOR tAKE HfH:' Drp!
AUTHORIZED FIRE DEPT. SIGNATURE
ORDERS WILL NOT BE PROCESSED WITHOUT
AU;,;OR'ZED1S'GNATURE
d~ )~~v.--e . __-
INSTALLATION ADDRESS
- REQUIRED BY FIRE DEPT.
- ATTACH LIST IF MORE ROOM IS NEEDED
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ORDER FORM - Payment must be submitted with order
SUB TOTAL
SHIPPING & PROCESSING CHG.
SUB TOTAL WITH SHIPPING CHG.
MINNESOTA SALES TAX, 6.5%
TOTAL AItIIOUNT ENCLOSED
White & YelloW ~ - DAMA CO.
ITEM
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE)
S3-SURFACE MOUNT
S3-SURFACE MOUNT WrrAMPER SWITCHES
R3-RECESSED MOUNT
R3-RECESSED MOUNT wrr AMPER
MOUNrING KIT (OPTIONAL FOR S-3
QTY
'.
PRICE
$107.00
$ 131 .00
$ 168.00
$160.00
$186.00
$ 59.00
MAIL TO:
TOTAL
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH, MINN.
55447
DARRYL SUNDBERG
763-559-3660
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Pink Copy - Customer