HomeMy WebLinkAboutFire Department Key Lock Box
THE DAMA CO.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
I PL:ASE READ
ORDERING INFORMATION:
SHIPPED JAN 2 5 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 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)
/.......-. ,/\ '\, '
( }!"p ll~"\I' li/' tr:t
--. .. .../.' r ' ,
C \'-/"';:'::'j]
'_." /. ......A.
\
Company t:i/~{(
t'.' '-. " ", : r"'-'"
Address j1ii ('-i
PRIOR tAKE PRE DEP ,
C. /S /.\ . , ! -. \/ \. . . i
Ity t ZI p\'t \ l Y l eH.., '1'1 \ \---.\
Attention of: t 1.\":, j-Gdd
.
AUTHORIZeD FIRE DEPT SIGNATURE
ORDER. sm. I ILL~i NO l1....R.~.! 'SSED WITHOUT
AUTHOfl~/~F.D. C}"J T~li .
.,/ ,/ ll/ .'~" f , ,: I I
(./ /' ~/, /"1
if,' l\ ,.....-.-....
J' ,I::t/i I).'" \.. ./'/" ~ .
fl [,.. 'i "/ ' i /
INSTALLATION ADDRESS
- REQUIRED BY FIRE DEPT.
. ATTACH LIST IF MORE ROOM IS NEEDI;O
,- .--. /'/
S Z c; 7 f':::.AM 'UI ~ c~ 7
7'=' K. 10 K 0-11c.:,' 6 ' ./
., /),
,.--...,.,.. "
-', (') ~-
ORDERED BY: DATE:
E~ ". /1/, /,/ T",., . ...
Company rl bLi::::'\....A't'.I:.:I< i ,t::/'t:L",~Dt.r:.;y-";
A d d.-, '7 /..; -- ,1:.::
ress ! ,,::-, I.."
tr.... <
, -., l' \, -., 1
') r" .,_..:1 \
City/St/Zip rR.fc:~ l.4Ice-' /Ilu
J . Q'::;7
N am e & Ph #'ll Ai I1C";X::.N Bt' /AA<;~ //1 '7 ":::,(;f.;f:;i'
/'. ,L
\ <-.'
MAIL TO:
ORDER FORM - Payment must be submitted with order
ITEM
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE)
S3-SURFACE MOUNT
S3-SURFACE MOUNT WITAMPER SWITCHES
R3-RECESSED MOUNT F"""t__
R3-RECESSED MOUNT WIT AM PER SWITCh;L.,Tf[" ,/
MOUNTING KIT (OPTIONAL FOR S-3 & R-3 rJiODELS ONLY)
QTY
, P"l T"".
.j .I
I ["
j f !
PRICE
$107.00
$131.00
$168.00
$160.00
$186.00
$ 59.00
SUB TOTAL
SHIPPING & PROCESSING CHG.
SUB TOTAL WITH SHIPPING CHG.
MINNESOTA SALES TAX, 6.5%
TOTAL AMOUNT ENCLOSED
White & Yellow Copy - DAMA CO.
TOTAL
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH, MINN.
55447
I ~.D, ')T)
DARRYL SUNDBERG
763-559-3660
1(. i /'/,
I ,.- '_..~" t :,-_,...t._"
$9.00
i] . i:",
I!, 'l,..C/
i ( t .
I "I "1 'l'J
I . I 1
Pink Copy - Customer