HomeMy WebLinkAboutFire Dept. Key Lock Box
THE DAMA CO.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
PLEASE READ
-+ ORDERING INFORMATION:
''') ,--
O\')~
0001_ 0
1) This order must be signed with the signature of the
authorized Fire Department official on file with the DAM A 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: /J
COR"lpany b/l ",JAY'4\. _\, Q L"" d.
Address ~~CJ 5' -;J d.. ;t/ /t ~
City/St/Zip &4r ~/ MN :;,-SJij
Attention of:
----------------------
ORDERED BY:
Company
Address
City/St/Zip
Name & Ph #
DATE:
FIRE DEPARTMENT INFORMATION
NAME:
PRIOR LAKE FIRE DEPT.
AUTHORIZED FIRE DEPT. SIGNATURE
ORDERS WILL NOT BE ROCESSED WITHOUT
AU~.~}, AT E,
.......... "
INSTALLATION ADDRESS P~NfoJltJ0 fU'"
- REQUIRED BY FIRE DEPT. PLAc.& cDN D05
- ATTACH LIST IF MORE ROOM IS NEEDED
IlL:>S?, 4- Fl-/irJgLlfiJ Tfb1/L 5E.
Pt2-IO(L ~~c:., 1!1/11S-~37z....
MAIL TO:
ORDER FORM - Payment must be submitted with order
ITEM
I S2,SURFACE MOUNT (NO MOUNTING KIT OPTION)
I S3-SURFACE MOUNT
I S3-SURFACE MOUNT WfTAMPER SWITCHES .
I R3-RECESSED MOUNT
I R3-RECESSED MOUNT WfTAMPER SWITCH
MOUNTING KIT (OPTIONAL FOR S-3 & R-3 ONLY)
SUB TOTAL
I 6.5% MINNESOTA SALES TAX
SHIPPING & PROCESSING CHG.
TOTAL AMOUNT ENCLOSED
White & Yellow Copy - DAMA CO.
QTY
PRICE
$ 103.00
$ 126.00
$16100
$154.00
$179.00
$ 56.00
TOTAL
DAMA-MP INC.
PO. BOX 47824
PLYMOUTH, MINN.
55447
DARRYL SUNDBERG
763-559-3660
$8.00
Pink Copy - Customer