ORDER FORM
Name:_______________________________________________Date Ordered:____/____/____
Address:_______________________________________________________
City:___________________________________ State:________ ZIP:_______
Phone Number:___________________ Check:______ Money Order:__________
| Select Type: |
Description: | Oty. | Price |
| _____ | Sign alone (numbered reflective sign only) | _____ | $20.00 |
| _____ | Sign with Post (Sign mounted on post - limtited to Thurston Co.) | _____ | $23.00 |
| _____ | Installation* (Sign installed in ground where requested)
|
_____ | $5.00 |
| _____ | Shipping (Areas outside of Thurston County- sign only, no post) | _____ | $3.00 |
| Total: | ________ | ||
* Installation available only in areas served by West Thurston Fire and Life Safety.
* Installation free to Senior Citizens living in areas served by West Thurston Fire and Life Safety.
Address Numbers Requested:
| _______ | _______ | _______ | _______ | _______ | _______ |
Additional Sign:
| _______ | _______ | _______ | _______ | _______ | _______ |
Please select how you want the numbers on the sign to be oriented:
| Check one | ||
| ________ | NUMBERS IN A HORIZONTAL ROW | 12345 |
| ________ | NUMBERS IN A VERICAL ROW | 1 2 3 4 5 |