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The fire department of___________________________________________________

in the state of ________ is contracting with Trilex for a period of 1 year for the services of cleaning and repairing personal protective equipment, starting the month of________________

and ending the month of____________________.  A set of gear will consist of pants, coat and suspenders in which the fire department / municipality agrees to pay for a total of ___________

sets x $ 45.50 per set ( a reduced savings of over 45% of the regular price of $ 71.50) for a total amount due of $_____________________ to be paid in ' advance" for the cleaning portion of the contract before any work commences.  The fire department understands that it is their responsibility to schedule the cleanings with Trilex.  If any monies are not used their is no carry over to the following year nor  are there any refunds.  It is the fire departments responsibility to maintain the program.  Trilex asks that a roster of members be sent in so that they may be entered into the system.  The price does include barcoding of the garments, but does not include return shipping costs which will be invoiced along with any repairs ( if noted or requested).  Trilex will send the department a detailed list of work performed for their record keeping.

Billing Adress:__________________________________________________________________

                     ___________________________________________________________________

Ship To:________________________________________________________________________

            ________________________________________________________________________

Contact Person:________________________________________________________________________

Phone:_______________________________________________________________________

Fax:_________________________________________________________________________

E-Mail:__________________________________________________________________________