HomeMy WebLinkAboutFire Department Key Lock Box
THE DAM"ll ,",v.'
FIRE DEPARTMENT
KEY LOCK BOX
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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.
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CUSTOMER INFORMATION FIRE DEPARTMENT INFORMATION
NAME:
SHIP TO: (DO NOT USE A P.O. BOX) PRIOR lAKE fiRE DEPT
Company G.I? {J(-..- (:" 1~.1 ..' f--y, r
Address /t 5 (0 flC( Ie Itv~ <:: /J".E'" AUTHORIZED FIRE DEPT SIGNATURE
City/St/Zip J Iltrl.f;;//./i;: ~' /711// '- (?79 ORDERS"VYILL NOTJE P~SSED WITHOUT
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ORDERED BY: DATE:;':) !1'7(::')~ i . v-.~ .,'" -1'/'" . /,,/' ._..'~
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Company G',' 'i'j l- \J "- -' ,-. yV'. ''-1- INSTAllATION ADDRESS
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i - REQUIRED BY FIRE DEPT.
Address \ ':-) \\ C> PA I ,2 ~ L/\ ,-....) G: - ATTACH LIST IF MORE ROOM IS NEEDED
City/St/Zip N l 0 li'~ \\A I'" L'\ N ;::'
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Name & Ph # 6-..:>/\. (l "1 f30p N '1 ~ 1 . '\ <\ ( , 4 be:. "1 ~(..)K' \lA (..J y\l1 ..:; - -"
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ORDER FORM - Payment must be submitted with order
MAIL TO:
ITEM
QTY
PRICE
TOTAL
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH, MINN.
55447
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE)
S3-SURFACE MOUNT
S3-SURFACE MOUNT WffAMPER SWITCHES
R3-RECESSED MOUNT '''''.
R3-RECESSED MOUNT v~r~1'7~ft~ SWITCH. ("-; ,..,~,
MOUNTING KIT (OPTION4,":f OR S-3 & R-3 M6~t;Y$,ojJLY)
"~UB TOTAL
SHIPPING & PROCESSING CHG.
$107.00
$131.00
$168.00
$160.00
$186.00
$ 59.00
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DARRYL SUNDBERG
763-559-3660
SUB TOTAL WITH SHIPPING CHG.
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$9.00
/1'7,00
MINNESOTA SALES TAX, 6.5% I / ,5'Q
TOTAL AMOUNT ENCLOSED I g ~ ,s~Cf
White & Yellow Copy - DAM A CO. Pink Copy - Customer