Knox Box Order Form

MABAS Wisconsin Knox Box Station Entry System

Date

Customer/Account Information

PLEASE PRINT OR TYPE THE INFORMATION BELOW, PLEASE, NO POST OFFICE (PO) BOX

Department Name:

Contact Name: *

Street Address: *

Street Address Line 2:

City: *

State

Zip Code

Phone Number:

E-mail Address *

Installation Address: *

Shipping Address (if different from above)

Fire Station Name (If Applicable:

Attention of:

Street Address

Street Address Line 2

City

State

Zip Code *

Order Information

Please Visit the Knox Box Website for Picture of the Below Items: http://www.knoxbox.com/store/

Item/Product Number /Price Per Unit

Quantity

Total $

KNOX 3200, HINGED DOOR; Surface 4H" X 5"W X 3-3/4" D; recessed 7"H X 7" wide with flange

Knox 3261 -

Surface Mount - Black

$502.00 Each

Quantity

Line Subtotal

Knox 3262 -

Surface Mount - Black

- Tamp Switch

$511.00 Each

Quantity

Line Subtotal

Knox 3263 -

Surface Mount -

Aluminum

$529.00 Each

Quantity

Line Subtotal

Knox 3264 -

Surface Mount -

Aluminum - Tamp Switch

$536.00 Each

Quantity

Line Subtotal

Knox 3265 -

Surface Mount -

Dark Bronze

$529.00 Each

Quantity

Line Subtotal

Knox 3266 -

Surface Mount -

Bronze - Tamp Switch

$536.00 Each

Quantity

Line Subtotal

KNOX 4400, DUAL LOCK, surface 6H X 6W X 4-1/2D; recessed 8-1/2H X 8-1/2W with flange

Knox 4401 -

Surface Mount - Black

$797.00 Each

Quantity

Line Subtotal

Knox 4402 -

Surface Mount - Black - Tamp Switch

$809.00 Each

Quantity

Line Subtotal

Knox 4409 -

Surface Mount - Aluminum

$831.00 Each

Quantity

Line Subtotal

Knox 4410 - Surface Mount - Aluminum - Tamp Switch

$845.00 Each

Quantity

Line Subtotal

Knox 4413 -

Surface Mount - Dark Bronze

$831.00 Each

Quantity

Line Subtotal

Knox 4414 -

Surface Mount - Dark Bronze - Tamp Switch

$845.00 Each

Quantity

Line Subtotal

MABAS-WI Master Keys, five(5) keys will be provided per Box; Additional or Replacement

MABAS-WI Master Keys

$15 Each

Quantity

Line Subtotal

Knox 3770, Exterior Padlock - All Weather Conditions

Knox 3770 - All Weather Condition Padlock

$125 Each

Quantity

Line Subtotal

Knox Key Control System

Key Secure 5 - Letter of Authorization for Purchase drafted by MABAS-WI

$20.00 Each

Quantity

Line Subtotal

Grand Total

Paypal Total

USD Grand Total

Send Check payable to: MABAS Wisconsin

Attn: Knox Box Coordinator

9830 29th Ave.

Pleasant Prairie, WI 53158-4414

Any question, please contact Paul Guilbert, Jr., at cppfr@wi.rr.com; 262.909.5972