Order Form

Upon receipt of this order, confirmation and pricing will be returned to the sender's address. Please contact Customer Service at 1-800-227-4116 or email us at cservice@maxonlift.com with any questions. Thank you for choosing MAXON.

Note: Fields with " * " must be filled.

Maxon Account #:

*Company Name:

*Contact Name:

*Telephone #:

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*Email:

Check if you do not have an email address

*P.O. #:

Date:

/ /

Billing Address:

*Company Name:

*Address:

*City:

*Country:

*Province/State:

*Postal/Zip Code :

Ship To:

Check if same as Billing Address

*Company Name:

*Address:

*City:

*Country:

*Province/State:

*Postal/Zip Code :

Shipping Instructions

•In the spaces below, please provide the name and phone number of your preferred carrier.

•To ship via Maxon's common carrier, leave those spaces BLANK. The freight charges will be included on your price confirmation.

Carrier Name:

Carrier Telephone #:

*Required Ship Date:

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Required In-House Date:

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Additional Delivery Instructions:

Quantity:

Vehicle Type :

Body Width :

Model:

Platform Type:

•One piece platforms include a 16" Aluminum Retention Ramp (ARR).
•Two piece platforms with an uneven split include a 12" Fixed Ramp

Platform Sizes

       Platform Width is:
       80" for 96" Wide Bodies
       86" for 102" Wide Bodies

For BMR-A-35
BMR-A-44

For BMR-A-55
BMR-A-66

For BMR-A-CS-35
BMR-A-CS-44

Ramp Options
For Steel Platform with Uneven Split ONLY

6" Fixed Steel
12" Fixed Steel
12" Fixed Ramp + 4" Cart Stop (Single)
12" Fixed Ramp + 4" Cart Stop (Dual)
16" Aluminum Retention

Standard Options

Power Down Option
Above Bed Travel Kit
Dock Seal Header Kit
Circuit Breaker Kit
Street Side Control For Power Down
Street Side Control For Gravity Down
Dual Controls For Power Down (Additional)
Dual Controls For Gravity Down (Additional)
Hand Held Remote For Power Down
Hand Held Remote For Gravity Down
Cab Cut Off Switch
Low Voltage Switch (Standard in Trailer Paks)
Cycle Counter
Circuit Breaker (150 Amp)
Dual Pump & Motor Assembly Up-Charge

Installation Kits And Battery Boxes Click Here For More Information

BMR-A Installation Kit I ( 3ft. form rear of vehicle)
BMR-A Installation Kit II ( 10ft. form rear of vehicle)
BMR-A Installation Kit III ( 20ft. form rear of vehicle)
Battery Box Without Batteries
Battery Box With 2 HD Deep Cycle 6 Volt Batteries Installed
Hanger Frame - Dual Pump Assembly Qty.
Hanger Frame - Battery Box And Dual or Single Pump Assembly Qty.
Truck Charge Line
Trailer Kit - Single Pole
Trailer Kit - Dual Pole

Trailer Pak Options Click Here For More Information

Tractor Kit 1-Single Pole
Tractor Kit 2-Dual Pole
Tractor Kit 3-Dual Adapter