KIRK® Replacement Key Form

Talk to an expert

INDEMNITY AGREEMENT
FOR DUPLICATE/REPLACEMENT/MASTER KEYS

Company Name:*

KIRK Acct # (if available):

Ship To Address:

Street Address*

City*

State*

Zip code*

Country*

Contact Person:*

Contact Email:*

Contact Phone #:

Bill to Address:

Street Address*

City*

State*

Zip code*

Country*

UPS/FedEx Acct#:

Attn:*

Payment Method: You must either upload a PO for the purpose of billing or provide credit card information to process at time of order

PO #:

** For credit card payment, please visit www.kirkkey.com/credit-card-order.
Once your online process is complete, provide the following information:

Last 4-digits of card:

Cardholder Name:

It is the responsibility of the purchasing company and/or end-user to apply administrative controls for the proper issuance and use of duplicate keys for there intended purpose. By signing this release you are agreeing to and in acceptance of all liability and responsibility for any event resulting in death, injury, equipment or property damage or linedown situations associated with your and/or any third party’s misuse or unintended use, installation, repair, modification, or any other act or omission relating to duplicate keys provided by Kirk Key Interlock Company LLC, or Castell Safety International and agree to defend, indemnify and hold harmless Kirk Key Interlock Company LLC and Castell Safety International from all claims, demands, and lawsuits including associated fees and costs incurred in connection with the foregoing.

Key Style	Qty	Duplicate Key Code	Key Interchange KIRK Only (Optional)	Sales Order# KIRK Only (Optional)	End User (Name & Address)
					End User Name* Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country
					End User Name Street address City State Zip code Country

Signature * [signature* usersignature cols:420 rows:100 class:sign_class]

Upload E-signature

Date*

Printed Name:*

Company:*

Title:*

Please click here to review our T&Cs. Accept our Terms and Conditions

Form approved by S. Kaufman 4/1/21

INDEMNITY AGREEMENT FOR DUPLICATE/REPLACEMENT/MASTER KEYS

INDEMNITY AGREEMENT
FOR DUPLICATE/REPLACEMENT/MASTER KEYS