Duplicate Key Release Form And Indemnity Agreement printable pdf download

DUPLICATE KEY RELEASE FORM AND INDEMNITY AGREEMENT

Bill To Address:

Ship To Address:

_________________________________

Telephone No. _____________________

Attn: _____________________________

Fax No. __________________________

P.O. No. _________________________

Credit Card Type (VISA, MC) __________________ Credit Card Expiration Date ____________

Credit Card No. _______________________________________________

Name on Card ________________________________________________

Duplicate Key Number(s)

End User (Company Name & Address)

___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________

___________________________________

__________________________________

Kirk Key SO No. _________________

(Found on nameplate of lock requiring duplicate key)

Dear Sir/Madam,

We acknowledge your request that Kirk Key Interlock Company, LLC (“Kirk Key”) supply you

with a duplicate or replacement key(s) for the above-noted KIRK® key interlock.

A key interlock system operates using interlocks and a limited number of keys in a predetermined

sequence. The purpose of this sequential operation of a key interlock system is to safeguard your

employees and to protect your equipment. The use of duplicate or replacement keys could provide

a means to circumvent the sequential operation of a key interlock system and thereby defeat the

protections afforded by the key interlock system. Consequently, any duplicate or replacement key

supplied by Kirk Key to you should be secured and controlled by a responsible person to prevent

any misuse of a duplicate or replacement key.

Kirk Key understands that end users may have the need for duplicate or replacement keys, but Kirk

Key has no way of evaluating an end user’s need for duplicate or replacement keys. Specifically,

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Duplicate Key Release Form And Indemnity Agreement