Security Plus GC-910-5 Directives D'installation page 3

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Security Cabinets and Safes Key or Combination Request
Verification of ownership is required in order to receive replacement key or confirm your combination
on your security product.
In order to receive a replacement key or obtain the combination to your security product:
Complete the following form and send to Stack-On Products.
1.
Send a copy of your valid driver's license along with the form.
2.
Send a copy of the receipt showing the original purchase.
3.
Security product owner must sign form.
4.
Owner's signature must be notarized.
5.
Send $10.00 for replacement key or combination. Personal Check, MasterCard, or Visa
6.
accepted.
Send completed information to:
7.
Serial Number______________________
Unit Dimensions________________________________________
Unit Description___________________________________________________________
Owner's Name ____________________________________ Date Purchased___/___/____
Owner's Address ___________________________ Unit or Apt Number _________________
City ___________________________ State _______________ Zip Code________________
Telephone Number: (____)___________________ Fax Number: (____)___________________
Owner's Email Address: ________________________________________________________
Owner's Signature __________________________ Notary Signature________________
Notary Commission Expires: _____/_____/_____ Notary Stamp
SERVICE REQUESTED
Combination confirmation:
$10.00 charge for this service
Key Replacement:
$10.00 charge for this service
Credit Card Information (Please circle one) MasterCard
Expiration Date: ___/___/___ Card Number:______________________________________
Credit Card Identification Number (Located on back of card, last 3 digits on signature strip)_________
9/07
"This is not a Registration Form"
Stack-On Products Company
1360 N. Old Rand Road
P.O. box 489
Wauconda, IL 60084
Key Number (if applicable) _______
Yes No
Yes No
Visa
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3
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4472-0707