Phase I

Personal Protective Equipment


Please fill out the following information, then print your completed order and submit as shown below.

Order Information:

Ordering Fire District/Dept:
Fire District DUNS Number:
Shipping Address:
Billing Address:
Contact Name:    
Contact Phone:    
Contact Email:    

How do you want it shipped? UPS Residential Business Warehouse pickup

Do you have a current DNR Agreement? Check one:

Forest Land Response Agreement And Federal Grant Agreement

Agreement Number:

Fire District Assistance Agreement

Agreement Number:

None (not eligible to participate)

Fire District Service Area Check one:

Rural area or rural community with a population of 10,000 or fewer residents

Community of more than 10,000 residents AND a service area that includes a rural community of fewer than 10,000 residents

None of the above (not eligible to participate)


Order form must be signed by a Fire District/Dept. authorized representative.

Name ________________________________________

Title __________________________________________

Signature ______________________________________

Pricing/Terms and Conditions of Sale:

Submit Phase 1 orders as follows: