Machine & Chain Order Form

Step 1 of 2

Date(Required)

Requested Dispatch Date(Required)

Purchase Order Number(Required)

Dealer information

Dealership(Required)

Dealer Salesperson(Required)

Dealer Email Address(Required)

Dealer Contact Number(Required)

Is this machine to be delivered directly to the dealership?(Required)

Delivery Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Customer Information

Customer Name(Required)

First Last

Customer Contact Number(Required)

Customer Email

Customer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Product Information

Model Selection(Required)

Model Price

Tyres

Tyre Price

Tyres

Tyre Price

Tyres

Tyre Price

Tyres

Dual wheel outer wing option

Hidden

4614 dual wheel price

Tyre Price

Tyres

Dual wheel outer wing option

Hidden

6218HDX dual wheel

Tyre Price

Tyres

Tyre Price

Chain Size

1204 Front Chain Selection

2006 Front Chain Selection

3009 Front Chain Selection

40 Front Chain Selection

4614 Front Chain Selection

6218HDX Front Chain Selection

8024 Front Chain Selection

Front Chain Price

1204 Rear Chain Selection

2006 Rear Chain Selection

3009 Rear Chain Selection

40 Rear Chain Selection

4614 Rear Chain Selection

6218HDX Rear Chain Selection

8024 Rear Chain Selection

Rear Chain Price

Sub Total

Discount Percent

Discount Total

Pre GST Total

GST

Total

Comment/s

Press the Next button to review your order before submitting the form to Kelly Tillage's offices.

Order Summary

	Item	Price
Product	{Model Selection:14}	{model price:128}
Tyre Option	{Tyres Standard 30 foot:111}{Tyres Standard 40 foot:112}{Tyres Standard 45 foot:113}{Model 46 tyres:143}{Model 46 dual wheel:145}{Model 50 Tyres:116}{Model 60CT Tyres:119}{60CT dual wheel:135}{62HDX dual wheel:138}{62HDX dual wheel floatation:139}	{Tyres Standard 30 foot Price:129}{Price:131}{Price:132}{Price:142}{Price:140}
Front Chain Selection	{6m Front Chain Selection:26}{30ft Front Chain Selection:64}{40ft Front Chain Selection:65}{Model 46 Front Chain Selection:146}{60CT Front Chain Selection:68}{62HDX Front Chain Selection:69}{80ft Front Chain Selection:70}{1204 Front Chain Selection:168}	{Price:28}{Price:89}{Price:90}{Price:147}{Price:93}{Price:94}{Price:95}{Price:169}
Rear Chain Selection	{6m Rear Chain Selection:30}{30ft Rear Chain Selection:71}{40ft Rear Chain Selection:72}{Model 46 Rear Chain Selection:148}{60CT Rear Chain Selection:75}{62HDX Rear Chain Selection:76}{80ft Rear Chain Selection:77}{1204 Rear Chain Selection:170}	{Price:32}{Price:96}{Price:97}{Price:149}{Price:102}{Price:101}{Price:171}
Sub Total:		{Sub Total:39}
Discount:		{Discount Total:106}
Total Before GST:		{Pre GST Total:107}
GST:		{GST:156}
Total:		{Total:157}

Order Summary

	Item	Price
Product	{Model Selection:14}	{model price:128}
Chain Size	{Chain Size:154}
Front Chain Selection	{6m Front Chain Selection:26}{30ft Front Chain Selection:64}{40ft Front Chain Selection:65}{Model 46 Front Chain Selection:146}{60CT Front Chain Selection:68}{62HDX Front Chain Selection:69}{80ft Front Chain Selection:70}{1204 Front Chain Selection:168}	{6m front chain price:28}{30 front chain price:89}{40 front chain price:90}{Model 46 front chain price:147}{60 front chain price:93}{62hdx front chain price:94}{80ft front chain price:95}{1204 front chain price:169}
Rear Chain Selection	{6m Rear Chain Selection:30}{30ft Rear Chain Selection:71}{40ft Rear Chain Selection:72}{Model 46 Rear Chain Selection:148}{60CT Rear Chain Selection:75}{62HDX Rear Chain Selection:76}{80ft Rear Chain Selection:77}{1204 Rear Chain Selection:170}	{6m rear chain price:32}{30ft rear chain price:96}{40ft rear chain price:97}{Model 46 rear chain price:149}{80 rear chain price:102}{62 rear chain price:101}{1204 Rear Chain Price:171}
Sub Total:		{Sub Total:39}
Discount:		{Discount Total:106}
Total Before GST:		{Pre GST Total:107}
GST:		{GST:156}
Total:		{Total:157}

By pressing the submit button you are sending this form to the Kelly Tillage head office. You will be directed to the machine order form signature page where you are required to sign the form for it to be processed.

This price list is only valid for 3 months from its effective date. Orders shipped past this 3 month period may be billed at a different rate. For clarity of pricing past this date, please contact your Kelly representative.

Name

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