Maxon Home

About Maxon
Service
Products
News
Employment
Contact Us
Orders
Order Info
Order Forms
Parts Order Status
Site Map

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:

Qty. Maxon P/N Description
*1. 
2. 
3. 
4. 
5. 
6. 
7. 
8. 
9. 
10. 
11. 
12. 
13. 
14. 
15. 
16. 
17. 
18. 
19. 
20. 
21. 
22. 
23. 
24. 
25. 

Additional Notes:


50th Anniversary