ALBURGH VOL. FIRE DEPT.
REFLECTIVE ADDRESS MARKER
ORDER FORM
Please complete the following information:
Name:_______________________________________________
Address:_____________________________________________
City, State, Zip:_______________________________________
Phone Number:_______________________________________
ADDRESS NUMBER REQUIRED
_____ ______ ______ _____ _____
NOTE: If your address has fewer than 5 digits, please “X” those boxes not used.
TYPE OF MARKER
MAILBOX: ______
(Green Background with white numbers)
VERTICAL: _____ HORIZONTAL: _____
HOUSE: _____
(Horizontal Only)
Make Check For $15 Payable to:
Alburgh Volunteer Fire Department
4 Firehouse Road
Alburgh, VT 05440
FREE INSTALLATION FOR SENIORS OR DISABLED RESIDENTS