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 #:

( ) -

*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:

/ /

Required In-House Date:

/ /

Additional Delivery Instructions:

Quantity:

Vehicle Type :

Body Width :

Model:

Platform:

Standard Options

Custom Color, other than black
On/Off Switch in Pump Box
Dual Pump Assy. Up-Charge

Trailer Paks Click Here For More Information

RC Trailer Pak I - Single Pole
RC Trailer Pak I - Dual Pole
RC Trailer Pak II - Single Pole For 6 Volt
RC Trailer Pak II - Single Pole For 12 Volt
RC Trailer Pak II - Dual Pole For 6 Volt
RC Trailer Pak II - Dual Pole For 12 Volt
RC Trailer Pak III - Single Pole For 6 Volt
RC Trailer Pak III - Single Pole For 12 Volt
RC Trailer Pak III - Dual Pole For 6 Volt
RC Trailer Pak III - Dual Pole For 12 Volt