HomeMy WebLinkAboutFire Department Key Lock Box
THE DAMA CO.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
PLEASE 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 OAM.l\ CO.
5) Allow 1-2 weeks for delivery.
CUSTOMER INFORMATION
SHIP TO: (DO NOT USE A P.O. BOX)
r
Company Q)Ug.Tt.LJ 000 V (LLAG.E ~5",
Address \ '109'- ADa~t-.J S1.1tfsrS,E
City/St/Zip Ptz-iorL LF\ILG' IN\;~i ~537z...
I
Attention of: DA V I (, 'is ER. tJlSo,.J
--------------------
ORDERED BY: DATE: ~ 7 (o~___
Company B~R.. (JJt-JSTfucTfO,..J
Address I fJ7 [) t2..l'VeYL~A:O
City/St/Zip 1)(2.6>582.. WI S~N~lN sJjtJQ
'., / / . :;,
'-:u .;i 60/ -.;;
Name & Ph # Dfl..." io Bt5l2...NT'S O,.J \-
C5.,/!
.,1-...
,- I'!. ~ ~ r-, f' ,
...~'.. ; .1',J >:....;" __)
~'~AR 4; 110m
FIRE DEPARTMENT INFORMATION
NAME:
PRIOR lAKE FIRE DEPT.
AUTHORIZED FIRE DEPT. SIGNATURE
ORDERS WILL N T BE PROCESSED WITHOUT
AUTHO I E F SI URE
.
INSTALLATION ADDRESS
- REQUIRED BY FIRE DEPT.
- ATTACH LIST IF MORE ROOM IS NEEDED
" II
NJ GLIV\AN;_ Sf: .?' f:. _~jl 1).
LA:lLE ~'f\JN. 55'572- _.
;e- I '7oq L
P1L.~ 01'-'
ORDER FORM - Payment must be submitted with order
ITEM
QTY
PRICE
TOTAL
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE) $107.00
S3-SURFACE MOUNT $131,00 /:":;V 0 ()
53-SURFACE MOUNT WfTAMPER SWITCHES $168.00
R3.RECESSED MOUNT $160.00
R3-RECESSED MOUNT WfT AMPER SWITCH $ 18600
MOUNTING KIT (OPTIONAL FOR 8-3 & R-3 MODELS ONIAE I~ ~\ n ~.\ 59.00
SUB TOTAL JI /c3/,DC)
-
SHIPPING & PROCESSING CHG. $9.00
SUB TOTAL WITH SHIPPING CHG. /y{). ()D
MINNESOTA SALES TAX, 6.5% (/~ / ()
MAIL TO:
DAMA-MP INC.
PO BOX 47824
PLYMOUTH, MINI'~
55447
DARRYL SUNDBEF1G
763-559-3660