Combination Request
“This is not a Registration Form”
Verification of ownership is required in order to confirm your combination on your security product.
In order to obtain the combination to your security product:
1. Complete the following form and send to Stack-On Products.
2. Send a copy of your valid driver’s license along with the form.
3. Send a copy of the receipt showing the original purchase.
4. Security product owner must sign form.
5. Owner’s signature must be notarized.
6. Send $10.00 for combination. Personal Check, MasterCard, or Visa
accepted.
7. Send completed information to: Stack-On Products Company
1360 N. Old Rand Road
P.O. box 489
Wauconda, IL 60084
Serial Number______________________
Unit Dimensions________________________________________
Unit Description___________________________________________________________
Owner’s Name ____________________________________ Date Purchased___/___/____
Owner’s Address ___________________________ Unit or Apt Number _________________
City ___________________________ State _______________ Zip Code________________
Telephone Number: (____)___________________ Fax Number: (____)___________________
Owner’s Email Address: ________________________________________________________
Owner’s Signature __________________________ Notary Signature________________
Notary Commission Expires: _____/_____/_____ Notary Stamp
SERVICE REQUESTED
Combination confirmation: Yes No
$10.00 charge for this service
Credit Card Information (Please circle one) MasterCard Visa
Expiration Date: ___/___/___ Card Number:______________________________________
Credit Card Identification Number (Located on back of card, last 3 digits on signature strip)_________
9/07
NOTE: You can store your Serial # and Combination on Stack-On’s SECURE web site – www.stack-on.com under
Service. Storing your Combination will provide instant access to this important information should you ever lose your
combination.
Only you will have access to this information.
®
40247-1312
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