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:

60" x 80" Wedge

Standard Options

Automatic Cart Stop (Dual)
Automatic Cart Stop (Single)
Trailer Under Ride Device (NHTSA FMVSS-224)
Sub-Frame Mounting Kit (Frameless Trailers)
2 Step Heavy Duty Dock Bumpers
102" Wide Extension Kit
Circuit Breaker Kit
Street Side Control For Power Down
Dual Controls For Power Down (Additional)
Hand Held Remote w/Coiled Cord And Plug & Socket For Power Down
Low Voltage Thermal Switch
24 Volt System Pump & Motor
Auxiliary Hand Pump

Trailer Pak Options Click Here For More Information

Trailer Kit A (Single Pole)
Trailer Kit A (Dual Pole)
Trailer Kit B (Single Pole)
Trailer Kit B (Single w/Batteries)
Trailer Kit B (Dual Pole)
Trailer Kit B (Dual w/Batteries)
Auxiliary Battery Box
Tractor Kit 1-Single Pole
Tractor Kit 2-Dual Pole
Tractor Kit 3-Dual Adapter