Address Sign Program Order Form

SOUTH LAKE COUNTY VOLUNTEER FIREFIGHTERS ASSOCIATION

P.O. Box 1193 • Middletown, CA 95461
Address Sign Program Order Form
Address Number*
Property Owner or Designee*
Name
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address same as Physical Address (note: signs are mailed)*

SameDifferent
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email for Order Confirmation*
example@example.com
Phone Number*
Please enter a valid phone number.
Orders are placed one a month and should arrive between two (2) to three (3) weeks from order date. If the sign order is for the purposes of meeting Public Resources Code 4290 requirements, Section 1274.08 Address for Buildings, 1274.09 Size of Letters, Numbers, and Symbols for Addresses, and 1274.10 Installation, Location and Visibility of Addresses, the sign order MUST be placed well in advance. A delay in the installation will not be grounds for granting final approval

Signs must be installed to the standards of the Public Resources Code 4290 requirements, Section 1274.10 Installation, Location and Visibility of Addresses, permanently placed at the driveway entrance and visible from both directions of travel along the road of at least 100 feet. (5 foot U-Posts are recommended for installation and can be purchased at most local hardware stores.)

By signing below, it acknowledges your purchase, as well as acknowledging installation requirements indicated above.
Signature

Clear
Suggested mounting hardware:

Cobb & Middletown: Sign is a 18"x 6" (horizontally) reflective address sign that may be mounted on a 5' green metal post.

Hidden Valley Lake: Sign is a 6"x18" (vertically)reflective address sign that may be mounted on an 4"x4"x6' wooden post.
Fire District Representative
Receipt Number
Date Order Form Received

MonthDayYear
Date
Date Order Placed

MonthDayYear
Date
Date Order Received

MonthDayYear
Date

Secured Address Sign Payment Link*

Customized Address SignWhite reflective letters on a green background. Sign is provided without post or hardware. Please allow for 2-3 weeks for delivery

$25.00

Customized Address Sign HVL Product Image

Customized Address Sign HVLWhite reflective letters on a green background. Sign is provided without post or hardware. Compliant with HVL CC&R's sign standard. Please allow for 2-3 weeks for delivery

$25.00

Total

$0.00

Credit Card

Should be Empty:

SOUTH LAKE COUNTY VOLUNTEER FIREFIGHTERS ASSOCIATION

Address Sign Program Order Form

Credit Card