Fire Station and Facility Fund Request

AFRD Station Number*

Name of Designated Captain or Company Officer that will communicate with the Foundation:*

First NameLast Name

Shift of Designated Captain*

Email*

example@example.com

Personal Phone Number*

Please enter a valid phone number.

Station Wishlist

	Item Description	Vendor	Quantity	Direct Internet URL to the Item	Item Cost	Estimated Tax	Est Shipping	Insurance Cost (if desired)	Final Cost
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34

Any additional notes or information

If requesting items that require an estimate or a quote, please attach the documents here.

I agree and understand the following (please check each box)*

I confirm that the items requested have been checked and confirmed that it meets the needs and specs of the station.I understand that all returns will be the responsibility of the station, unless delivered damaged or otherwise discussed with Atlanta Fire Rescue FoundationI understand that 5% of the station's allocated funds will be taken out for foundation related costs for management of the Fire Station Fund Program.I confirm that all three shifts have been consulted and have agreed upon by vote on the items listed above.