Form Center

2. CHFD Fire Safety Registration, Permit, & SDI Inspection Fees
   VISA, MASTERCARD, DISCOVER ONLY
3. Fee Category/Amount*
   -- Select One --B-1 Fee - 70.00B-2 Fee - 140.00B-3 Fee - 200.00B-4 Fee - 400.00B-5 Fee - 450.00B-6 Fee - 550.00B-7 Fee - 600.00B-8 Fee - 650.00B-9 Fee - 700.00B-0 Fee - 35.00CA Fee - 70.00R-1 Fee - 50.00R-2 Fee - 100.00R-3 Fee - 200.00R-4 Fee - 600.00R-5 Fee - 1000.00Type 1 Permit Fee - 100.00Type 2 Permit Fee - 400.00Propane Exch Permit Fee - 166.00Propane Exch Permit Fee Type 2 - 350.00SDI Fee/3ays or less - 162.00SDI Fee/4-7 days - 115.00SDI Fee/8+ days - 100.00SDI/Sr./3 days or less - 132.00SDI/Sr./4-7 days - 85.00SDI/Sr./8+ days - 70.00Report - 25.00Penalty/Fine - 250.00Penalty/Fine - 500.00Penalty/Fine - 750.00Penalty/Fine - 1000.00Penalty/Fine - 1500.00

   Select fee amount.

4. Payment Type*

   1. Visa
   2. MasterCard
   3. Discover
6. Taxable
7. Shipping Cost
8. Quantity
10. Account Number*

    7 digits

11. Invoice Number*
12. Invoice Date*
    Invoice Date
14. Business Name*
16. Address*
17. Zip code*
    -- Select One --080020803408003
21. Accounts Payable
23. Business Name*
25. First & Last Name*
27. Address*
29. City*
30. State*
31. Zip*
33. Phone Number*
34. Email Address*
36. REFUND POLICY:
    Refunds will be issued for duplicate payments and payments made in error only.
Leave This Blank:


38. Calculate Totals Proceed to Checkout

* indicates a required field