R
40261-1101
12
3
Key Request
“This is not a Registration Form”
Verification of ownership is required in order to receive replacement key for your security product.
In order to receive a replacement key to your security produc
t:
1.
Complete the following form and send to Stack-On Products.
2.
Send a copy of your valid driver’s license along with the form.
3.
Send a copy of the receipt showing the original purchase.
4.
Security product owner must sign form.
5.
Owner’s signature must be notarized.
6.
Send $10.00 for replacement key. Personal Check, MasterCard, or Visa accepted.
7.
Send completed information to:
Stack-On Products Company
1360 N. Old Rand Road
P.O. box 489
Wauconda, IL 60084
Serial Number______________________
Key Number (if applicable) _______
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
Key Replacement:
Yes No
$10.00 charge for this service
Credit Card Information (Please circle one) MasterCard
Visa
Expiration Date: ___/___/___ Card Number:______________________________________
Credit Card Identification Number (Located on back of card, last 3 digits on signature strip)_________
