Hoist & Cord Reel Assembly Kit:
     

Use the paypal button above to order immediately or print form below and send it by mail, email, or fax along with check or purchase order to:

Dave Adams
Matlamps
130 Candice CT.
Medford, OR 97504-9609
Phone(541)772-6742
Fax (541)245-3878
e-Mail : dave@matlamp.com

Name:

School/Company:

Street Address:

City:

State:

Zip:

Number of Hoists (with Reel): ___ x ($750 +$75 shipping) = $ ________

Number of Lamps: ____ x ($725 +$75 shipping) = $ ________

Paypal Charge: ($25 x Number Ordered) = $ ______

Total = $ _________

PO or Check Information:

Phone:

Fax:

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