Carbondale Township Fire Department

2005 Magnet Fund Raiser

1125 E. Park Street

Carbondale, IL 62901

(618) 549-4621 (Non Emergency)

(618) 549-9654 (Fax)

Name:___________________________________________

Agency:_________________________________________

Phone:__________________________________________

Address:________________________________________

City:____________________________________________

State:___________________________________________

Zip:_____________________________________________

Firefighter Rate: 

$3.00 x ______ = ______

General Public:    

                                                $5.00 x ______ = ______

Shipping & Handling (US Only):                          $1.50

Total:                                                                     ______

* Please Make Checks Payable to “Carbondale Township Fire Department Volunteers”