HomeMy WebLinkAboutFire Department Key Lock Box
THE D~ /0.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
I PL: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.
S/1/PPED FEB
o 7 2007
CUSTOMER INFORMATION FIRE DEPARTMENT INFORMATION
NAME:
SHIP TO: (DO NOT USE A P.O. BOX)
c- . (2;;JtJSjK i/ CT7f},1 ) PRIOR LAKE FIRE OEPT
CompanWl1 f/ el /)(?t
//800 SIA16L t 7'""f 1::- F ./ f:t
Address /;,;!Y; /.) I:- 3(),~ AUTHORIZED FIRE DEPT. SIGNATURE
City/St/Zip cD/:- AJ j/ '. /h,U <;5 3 yl..! ORDERS WILL NOT BE PROCESSED WITHOUT
'K;4 if It- AUTHORIZED F.D. SIGNATURE
"
-"~)
Attention of: I{O N 0/1 ;:;:::7 c- / v
~--------------1-7----
ORDERED BY: DATE: \ I~u /V'--"'
Company ""::::>OLJiNi2,j)<.:;;>'? C al'~ S II' -' '.'_ t" ".....J INSTALLATION ADDRESS l)r..J ...,<:.....: h:,..," ~,-(-1(,
SI.r-Jbtc: flll:'c:'" L/1"-J1...- 11-'0 -;> - REQUIRED BY FIRE DEPT.
Address I \ 9,,<...-'0 ::> ...... ATTACH LIST IF MORE ROOM IS NEEDED
-
City/St/Zip L (:'(; 1'-.../ ~ 1\ //2 1(' /J~~, ~ \ .:"44 i
5~2..:- (;. /::',A IV /fc: C,~", ,- s C.
f
Name & Ph # 11,,1 I~ I( ,J.;/t (v ~/N 15 2 . .5 2 '1 . Cl ';''-?;. P (L f 0(1. LA IL\~ , IN^-, <:;\-::"'-72-.
ORDER FORM - Payment must be submitted with order
ITEM
PRICE
TOTAL
QTY
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE) $107.00
S3-SURFACE MOUNT I $131.00 I -
1 ,j
S3-SURFACE MOUNT W(TAMPER SWITCHES $168.00
R3.RECESSED MOUNT $ 160.00
R3-RECESSED MOUNT W(T AMPER SWITCH $186,00
MOUNTING KIT (OPTIONAL FOR S-3 & R-3 MODELS ONLY) $ 59.00
SUB TOTAL ~ /3/.-
~ SHIPPING & PROCESSING CHG. $9.00
SUB TOTAL WITH SHIPPING CHG. /1../0. tH.J
MINNESOTA SALES TAX, 6.5% 9/()
TOTAL AMOUNT ENCLOSED /Ljq, j() .
White & Yellow Copy - DAMA CO.
Pink Copy - Customer
MAIL TO:
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH, MINN.
55447
DARRYL SUNDBERG
763-559-3660
v/~-