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REFLECTIVE ADDRESS SIGNS

Make your residence easy to find for:

Postal service - Emergency and Fire - Deliveries - Visitors

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REFLECTIVE ADDRESS ORDER FORM

NAME:_____________________________________________________________

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ADDRESS:__________________________________________________________

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CITY, STATE & ZIP CODE:____________________________________________

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PHONE NUMBER:____________________________________________________

ADDRESS NUMBER REQUESTED

Note: If your address has less than 5 digits, start on the left and (x) those boxes not used

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MOUNTING PREFERENCE

HORIZONTAL

HORIZONTAL:____

VERTICAL:_____

ONLY $15.00

MAKE YOUR CHECK FOR $15.00 PAYABLE TO: PAVILION TOWNSHIP

MAIL TO: PAVILION TOWNSHIP, 7510 EAST "Q" AVE., SCOTTS, MI 49088-9710

A SERVICE OF PAVILION TOWNSHIP FIRE DEPARTMENT

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