Use this form to select an order option below:
Hoist & Cord Reel Assembly Kit:
Dave Adams
Matlamps
130 Candice CT.
Medford, OR 97504
Cell 541-326-9397
e-Mail :
dave@matlamp.com
Name:
School/Company:
Street Address:
City:
State:
Zip:
Number of Hoists (with Reel): ___ x ($975 +$100 shipping) = $ ________
Number of Lamps: ____ x ($950 +$100 shipping) = $ ________
Total = $ _________
PO or Check Information:
Phone:
Fax:
Comments?: