Form Center

Step One

Section 1: Ordered By
Ordered By
1. Contractor
2. Government/Military
3. Property Owner
Product For
1. Campus/School
2. Commercial Property
3. Government
4. Healthcare
1. Hospitality/Hotels
2. Military
3. Other
Company/Agency
Date Ordered
Date Ordered
Street Address
Suite/Building
City
State
ZIP Code
Contact Name
P.O. Number (Government Agencies Only)
Phone Number
Email Adderss
Section 2
Order Will Not Be Processed Without Authorized Signature
1. I agree
System Code: PS-01-0513-05-97
By checking the "I agree" box, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Date
Date
Important Note
1. Check here to Sub-Master. Sub-master fee is $7 per keyed item.
Knox Master Keys are provided to authorized agencies or other registered entities on an as-needed basis solely for use with the Knox Rapid Access System. No other use of the Knox Master keys or their associated codes is authorized or permitted. Knox Master Keys and Key Codes associated with the Knox Master Keys and Keyways remain the exclusive property of the Knox Company. Key Codes associated with the Knox Master Keys and Keyways are maintained by the Knox Company in Phoenix, Arizona. For questions regarding this policy, contact Knox at 800-552-5669.
Authorized Agency Signature
1. I agree
By checking the "I agree" box, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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Step Two

Section 3: Order Product
Use the attached price list (PDF).
Quantity and Weight (Each)
Model Number
Price (Each)
Extended Price
Quantity and Weight (Each)
Model Number
Price (Each)
Extended Price
Quantity and Weight (Each)
Model Number
Price (Each)
Extended Price
Sub-Master Fee
(if required, $7 each)
Shipping and Handling
Ground Shipping & Handling
1 to 7 pounds is $15
8 to 16 pounds is $28
17 to 30 pounds is $42
31 to 50 pounds is $52
51 to 75 pounds is $62
Rush?
1. Next Day Air
2. 2nd Day Air
Call for rates and check which box.
Office Use Only
O/N and received
Subtotal
Sales Tax
California tax required.
Pre-Payment Total
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Step Three

Section 4
Installation Address - Required By Authorized Agency
1. New Construction
2. Retrofit
Building Name
(Where the item will be installed)
Address
No P.O. boxes.
City
State
Zip Code
Section 5
Ship to Address is Required
1. Same as Install Address
2. Different Address
Address
City
State
Zip Code

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Knox Box Authorization Order Form

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