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Reflective Address Marker Order Form - Fire Department

  1. Please complete the form below and mail or drop off a check in the amount of $15.00 to: 4 South Eagleville Road, Mansfield, CT 06268 ATTN: Reflective Sign. Checks should be made out to: Mansfield Fire Department. Please allow 6-8 weeks for delivery.
  2. Single or Double Sided?
    If you plan on posting your sign on a fixture that allows only one side to be seen, please select single. For mailboxes or other fixtures that will be seen from both sides please select double.
  3. Mounting Preference: Horizontal or Vertical
  4. ADDRESS NUMBER REQUESTED
    Note: If your address is less than 4 digits place and X starting at the left.Example: “X879”
  5. Leave This Blank:

  6. This field is not part of the form submission.