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200o F�re/Police Rapid Entry System . ,� <br /> Effective 1/1/2000 AUTHORIZATION/ORDER FORM *°� <br /> ORDERED BY: INSTALLATION ADDRESSES <br /> c, / � (Requfred by Fire Department) � <br /> Company/Persom�)AA�D,e�1 �1 ��/f� Date: List street addresses and cities where items <br /> �n� � /� will be installed.At;ach separate sheet for <br /> StreeL l �'c���a_)f�V H'IfG ��i additional installation addresses. <br /> Ciry/State: �Uc'f'F �� (�� Zip: l� 3 1. BItlg.Name <br /> Contact Person�s(1-�DEE j i�i"��P� Phone: ('�2S)'��F3 -L3�7 , Sireet,�d�'I ��'"d Ad c��l y HbG <br /> P.O.# (Gov. agencies only): City�Ut41`e�� � Cv/� 9 " (7S <br /> (OMer�una�r 5700 nauirr Onpaym�nt.) <br /> SHIPTO:(Street Address ONLY - No P.O.Box.) 2. Bldg.Name <br /> Company/Person:T) A�J l�E� �l�""��P� Street <br /> st�eec:Jon�� - QroA�J,4y �A�tse;-f� C�. �iry <br /> City/State: � /I(�-f'�'T''� � � Zip:�l�3 <br /> �1 � / /� ' ' • ' �i _ • <br /> Contact Person:oN11� D�'�' (,1"�TlriPhone: ('y�.$) 7�3 -133�'1 <br /> Fe � <br /> . • � . • . . • <br /> . . � <br /> ❑ �le to: <br /> � � <br /> r—.��r_�tE_:�� �;k�e: air:r�:� .. � �93 <br /> 2L'9'f O1�Kt:$ r1'r`fc Ce <br /> ' � — <br /> . .S� n1inX lo <br /> Ei/ERETl' WA 9a201- <br /> c /� ti: L�11 � !�� .,� <br /> . '�2�� <br /> A THORI2E FIRE NCY SIGN RE S5 .q <br /> !� <br /> PS-'OU-0"1.2 ' <br /> VE. <br /> System Code <br /> � ii • � � � � � <br /> aty. Part N Item Descriptfon Color Welght Price Ea. Total IMPORTANT <br /> �� � oD � o� ❑ Check here if <br /> . products ordcred on <br /> this form must be <br /> DUAL KEYED <br /> MAKE CNECKS PAYaBIE TO: KNOX COMPANY suarora� S� Add 57.00 to EACH <br /> � � � Shipping & Handling Add Sales Taz if Applicahle item ordered <br /> , lor. CA',GA,IL, NJ,OH $ <br /> 1 Ib. ta 251bs. S70.00 Shippinp&Handling 5 i0• �' a <br /> I i i ' � 261bs. to SO lbs. 520.00 TOTAL: S 'I�S z' aKN�x <br /> ' � � � ' ' ' S1 Ibs.to 75 Ibs. 530.00 800•552-5669 •949•252-8181 <br /> � ' 75IIzs.rrallKnar/aquofe. •CATax:7.25°h • ca,OranpeCountyTai:7.)5°/. Fax: 949-252-0482 <br /> www.knoxbux.com <br /> ����� <br /> . 0 CODynpnb NNO%COMPANY 1999 <br />