PAVILION TWP. VOL. FIRE DEPARTMENT

REFLECTIVE ADDRESS MARKER
ORDER FORM
Please complete the following information:

 
Name________________________________________________________
Address______________________________________________________
City, State, Zip________________________________________________
Phone Number________________________________________________
 

Address number requested


Note: If your address has fewer than 5 digits, start at the left and x those boxes not used

 

Mounting Preference

  

Horizontal

V
e
r
t
i
c
a
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ONLY $15.00
Let us know if you require brackets.


HORZ_______

VERT_______

ENCLOSE CHECK (Payable to Pavilion Township) AND FORM
Mail to: Pavilion Township
7510 East "Q" Ave.
Scotts, MI 49088-9710