South Boston Fire EMS

 

Auxiliary

 

Reflective Address Marker

Order Form

 

Please print and complete the following information

 

Address Number Requested

 

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

 

 

Mounting Preference (Please circle one)

 

HORIZONTAL (ø)                VERTICAL (ù)

 

 

 

All orders must be paid in advance.

 

Make checks payable to: South Boston Fire Company Auxiliary

 

Mail Orders to:        South Boston Fire Department

P.O. Box 221

South Boston, VA 24592

Attn: Name Plate Fund Raiser

 

Orders may be picked up at the Fire Station. We will contact you to make arrangements once your plate is complete.  All orders must be paid in advance.  All sales are final.   PLEASE MAKE SURE TO INCLUDE YOUR PHONE NUMBER ON THIS ORDER FORM.