REFLECTIVE ADDRESS MARKER
ORDER FORM
Please complete the following information:
Name___________________________________________
Address_________________________________________
City, State and Zip _________________________________
Phone Number____________________________________
Email Address (if applicable)__________________________
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Write
Your Address Number Below
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Note: If your address has less than five
(5) digits, place an X in the remaining "blank"boxes
Mounting Preference
MAILBOX
($15)
BLUE______
GREEN_____
VERTICAL___ HORIZONTAL___
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HORIZONTAL
Mail Check and form to:
Bertlin Twp. Fire Dept.
c/o Reflective address marker
P.O. Box 53
Allenton, MI 48002
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