1601 W. Deer Valley Road • Phoenix • Arizona 85027 • (800) 552-5669 • (623) 687-2300 • Fax (623) 687-2296
Use this form to: Delete/Add Authorized Signers and Update Knox Coordinator
Department Name Date
Mailing Address
City State Zip
Phone Fax
System Code # Email
Request for changes in this area are honored only if signed by a Current Authorized Signer.
Please DELETE the following names from the "Authorized Signature" list:
1. 4.
2. 5.
3. 6.
Please ADD the following names to the "Authorized Signature" list: (Authorized signers with the “Orders” box checked have the authority to request installation reports, add/delete authorized signers, and authorize property owners order forms. To have the authority to request additional master keys, the “Keys” box must be checked. Please check the applicable boxes for each authorized signer.)
Name & Title Signature Keys Orders
1.
2.
3.
4.
Please update our Knox Coordinator to the following: (the Knox Coordinator is the primary point of contact for your department’s Knox System)
Name Title
Phone Email
Name and Authorized Signature of the person submitting this form: (Must be a current authorized signer.)
Name Authorized Signature