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HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 9125714'9 VI V V 10/24/2012 WEB 9:44 FAX 970 221 6635 PFA FIRE PREVENTION BUR. 2002/013 O a x ® KNNOX' Rapid Entry System Fire • EMS • Law Enforcement -Government 2012 AUTHORIZATION ORDER FORM 800-552.5669. 623-687-2300 • Fax: 623-687-2290 • WWW.KNOXBOX.COM �ZgD(o Effective M,ji-138704t January.1, 2012 FjORT C LLIN , 'O 80524-2834 : r l l Authorizing Agency Approval Signature Required / E_ ' Z' . to Sub -master Items Authorized Agency Signature and Date Print Name Cleady O Check here to Sub -master PS-07.0027.11-83 Submastar fee $7.00 per keyed Rem. System Code AuthadzedAgencySioadture , • 1 a a r Quantity Part# Weight Ea. Price Ea. Extended Price [3 Check or Money Order made payable m 2. ' m $ �® $ y q � 2� 2 p®mm PAN 1 XNOXCOMPANYFederal l.D.696-3617e58 m � m $=m $i__I__1__l-M CardholderSlpnalure m FTTM m $=m $F7FTF]m ❑VISA ❑MC CARDNUMBER - ,_, , Sub -master Fee IN required,$7.00 ea.)$ rTTTI ❑AMEX ❑DISC rift.' Shipping and Z � EXP. �DATE 'r}(PA'Mt YY) NAMEONCAAD C rdOrders Handling $ ,® canes FA%Ellm Subtotal s'annadand to; $�.m F�L�F--E...-r oxco oNerse•Im�oxcwn NO TAX REQUIRED a • : r Sales Tax $ BUILDING NAME (WHERE ITEM WILL SE INSTALLED)- PLEASE TYPEADDITIONAL INSTALLATION AOORESSESON A SEPARATE SHEET(nEDUMEB BYTIBE DEPT.) Pre -payment btat$©. (7 Ground Shipping 8: Handling STAEET ADDRESS NO P.O. BOXES Ilb. to 7lbs. $13.00 Please call 8lbs. to 161bs. $26.00 Knoxlorquole: ciTv STATEZIP CODEbs. to 30 bs. $4.00 7516s,ldR 31 bs. to 50lbs.. $45.00. Alaska,Niwail,f 31 l 51lbs. to 75lbs. $60.00 Canada E t SHIP TO CONTACT NAME EvFe- 2. COMPANYNAME OFFICE FIFI LE USE ONLY OIN RECD G lal III-1fJ_,-Y