© 2014 Allegion
Printed in U.S.A.
009160 Rev. 02/14-a
Dealer or Primus locksmith authorization (option with owner authorization/signature)
Dealer or locksmith account #
Primus #
Address
City
State
Zip
Contact 1 (please print or type)
Contact 1 signature
Owner authorization/signature
Date
Name/title
Phone
FAX
Contact 2 (please print or type)
Contact 2 signature
Effective from (Month/date/year) to (Month/date/year)
Special note:
In the case where the end user/owner has assigned the Dealer or Primus Locksmith signature
authorization (as noted above), the Dealer or Primus Locksmith agrees to take full responsibility for
validating the owner’s signature as identified on the Primus signature card before ordering the material.
Special instructions:
Please indicate any restriction to authorized individuals listed on this form when purchasing additional Primus product or duplicating
keys.
Please fill out a new Primus signature card in the event of changes, additions or deletions in Authorized signature and send with
letter requesting changes to Schlage at the address below. Primus signature cards are available from authorized Schlage Primus
distributors and Schlage Commercial upon request. We suggest that you make a copy of this completed form for your records. A
photo copy or fax of this card will not be accepted.
Please mail the original copy to:
Allegion Security Technologies - Schlage
Attn.: Primus Order Processing
3899 Hancock Expressway
Security, CO 80911
Faxed copies not acceptable
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