911 Fire Decal Order Form

"*" indicates required fields

Date*

Fire Department Name*

Contact Name*

Contact Phone Number*

Mailing Address*

Street Address Address Line 2 City Province Postal Code

Delivery Method*

Mail to address provided above

Pick-up at 911 Division office

Decal Quantities

911 EMERGENCY - DECAL SIZE: 13” X 8” (Small square) - Quantity:

911 EMERGENCY - DECAL SIZE: 21.5” X 13.25” (Large square) - Quantity:

EMERGENCY 911 - DECAL SIZE: 49” X 4.75” (Rectangle) - Quantity:

Privacy Statement: The personal information collected in this form will be used only for the for the purpose of fulfilling an order for decals. This information is being collected in accordance with section 61(c) of the Access to Information and Protection of Privacy Act, 2015 (ATIPPA, 2015). All information provided will be maintained in a secure manner and confidentiality will be protected, as required by the ATIPPA, 2015. For questions or comments related to the protection of your personal privacy, please e-mail 911info@gov.nl.ca