Hoist & Cord Reel Assembly Kit:
     

Dave Adams
Matlamps
2414 Jolissaint Ave.
New Albany, IN 47150
Phone 812-590-1363
Cell 541-326-9397
e-Mail : dave@matlamp.com

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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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