Medeco Security Locks Source Designation Form SDF Lock Dist

User Manual: Medeco Security Locks Medeco Source Designation Form Miscellaneous

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Security Lock Distributors • Source Designation Form
The Medeco Source Designation Form (SDF) is necessary if you wish to purchase your restricted
keyway products from Security Lock Distributors. You do not need this form to buy direct from
Medeco, nor are you restricted in your ability to purchase directly from Medeco. This SDF gives
your authorization for an additional source for your Medeco restricted products. This form must
be completed, signed, and returned to Medeco either by fax or mail for us to authorize Security
Lock Distributors to sell you restricted products. Please allow 24 hours after we receive this
document to extend authorization to Security Lock Distributors.
This form is only applicable if you have a valid restricted keyway agreement with Medeco. If
you wish to inquire about Medeco Restricted Keyways for your business, or if you are not sure if
you need to send one in, contact your local Medeco Sales Representative or call Medeco
Customer Service at 800-839-3157.
Lockshop Name:

Medeco Acct. #

Print Your Name:
Signature:

Position:

Address:
City, State, Zip:
Telephone:

Today’s Date:
Complete the appropriate sections: (Please Print Clearly or Type)

I want to purchase ______ KeyMark Restricted Keyway Product from Security Lock Distributors.
For Medeco Use Only: Conf: ______ CC# ______ Sys Ent Date: ______

I want to purchase ______ DBK Restricted Keyway Product from Security Lock Distributors
For Medeco Use Only: Conf: ______ CC# ______ Sys Ent Date: ______
I want to purchase _____Medeco Electronic Access Control Products from Security Lock Distributors.
For Medeco Use Only: Conf: ______ CC# ______ Sys Ent Date: ______

I want to purchase Patriot/Freedom (circle one or both) Restricted Keyway Product from Security Lock Distributors.
For Medeco Use Only: Conf: ______ CC# ______ Sys Ent Date: ______

I want to purchase ______ Medeco3 DB3 Restricted Keyway Product from Security Lock Distributors
For Medeco Use Only: Conf: ______ CC# ______ Sys Ent Date: ______ Slider_________

Medeco Authorization: ___________________________________ Date: ________________
Return this form to Medeco Security Locks, 3625 Allegheny Drive, Salem, VA 24153. FAX: 540-380-1714
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