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SS31:1aav 3.116 alloo3m N01 .1.33dSNI . NOI133dSNM]NV ONldllna 13 NI vi ei Oiled AO 1N3ININVd30 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 Are 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 SHIPPED JUN 0 4 2014 Department for specific mounting requirements. 3) Please include 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. CURER INFORU ION FIRE DEPARTMENT INFORMATION NAME: SHIP TO: (DO NOT USE A P.O.BOX) PRIOR LAKE FIRE DEPT. Company `IA. N' 4 J I L.- F..x. Address di cow , t-1 "'s — ° AUTHORIZED FIRE DEPT.SIGNATURE City/St/Zip 12t.----(tyti)."-ru t N1 t t Attention of: T ak. �� bs�� ORDERED BY: DATE " Aro COMPany VAN '4 -4111-C r" INSTALLATION ADDRESS Address ' t 7" (� - REQUIRED BY FIRE DEPT. A U t - ATTACH UST IF MORE ROOM IS NEEDED646 4 I4-- City/S't/Zip e rfs 43-4-z L Name&Ph# 45' N - I - _ ORDER FORM-Payment must be submitted with order OAK TO: DAMA-MP INC. ITEM QTY PRICE TOTAL P.O.BOX 47824 S2-SURFACE MOUNT(NO MTG KIT OPTION AVAILABLE) $116.00 PLYMOUTH,MINN. 5,5447 S3-SURFACE MOUNT $141.00 S3-SURFACE MOUNT W/TAMPER SWITCHES $178.00 R3-RECESSED MOUNT $170.00 Li C) 763-559-3660 R3-RECESSED MOUNT W/TAMPER SWITCH $196.00 MOUNTING KIT(OPTIONAL FOR_ S3&R3 MODELS ONLY) $68.00 11"01 itSUB TOTAL I SHIPPING AND PROCESSING CHG. $10.00 SUB TOTAL WITH SHIPPING CHG. 10 ;'Q ;STATE SALES TAX= 6.875% 1 . 727 TOTAL AMOUNT ENCLOSED 2-- 5-1 WHITE COPY:SEND TO DAMA YELLOW COPY:FOR CUSTOMER