Machine & Chain Order Form

Date*
DD slash MM slash YYYY
Requested Delivery Date*
DD slash MM slash YYYY
Purchase Order Number*
Dealer information
Dealership*
Dealer Salesperson*
Dealer Email Address*
Dealer Contact Number*
Where will this machine be delivered?*
This is the address that will be used for transport quotation.
Delivery Contact Name*
First Last
Delivery Contact Number*
Delivery Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Customer Information
Customer Name*
First Last
Customer Contact Number*
Customer Email
Customer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Customer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Product Information
Model Selection*
Price
Chain Size
Tow Hitch
110 x 100mm 8 bolt pattern
Price
.
Tow Hitch
110 x 100mm 8 bolt pattern
Price
.
Tow Hitch
160 x 160mm 12 bolt pattern
Price
.
Tow Hitch
160 x 160mm 12 bolt pattern
Price
.
Brakes
Front Chain Selection
Front Chain Selection
Front Chain Selection
Front Chain Selection
Price
Price
Price
Price
Rear Chain Selection
Rear Chain Selection
Rear Chain Selection
Rear Chain Selection
Price
Price
Price
Price
Additional Products
- Spare Parts
Quantity
Part
Price
Quantity
Part
Price
Quantity
Part
Price
Hidden
Spare Parts prices
- Additional Chain
Additional Front Chain
Additional Front Chain
Additional Front Chain
Additional Front Chain
Price
Additional Rear Chain
Additional Rear Chain
Additional Rear Chain
Additional Rear Chain
Price
All prices are Ex Stolpen Germany
Total Order Value
(VAT should be applied at 19% for applicable customers.)
Plus freight as quoted.
10% Deposit
Comment/s

Order Summary

Item Price

Product {Model Selection:14} {model price:128}

Tow Hitch {tow hitch:173}{tow hitch:174}{tow hitch:175} {tow hitch price:176}{tow hitch price:177}{tow hitch price:178}{tow hitch price:215}

Brakes {brakes:180}

Front Chain Selection {1204 Front Chain Selection:216}{6m Front Chain Selection:26}{9m Front Chain Selection:64}{12m Front Chain Selection:65} {1204 Front Chain Price:217}{6m front chain price:28}{9m front chain price:89}{12m front chain price:90}

Rear Chain Selection {1204 Rear Chain Selection:218}{6m Rear Chain Selection:30}{9m Rear Chain Selection:71}{12m Rear Chain Selection:72} {1204 Rear Chain Price:219}{6m rear chain price:32}{9m rear chain price:96}{12m rear chain price:97}

Spare Parts {quantity:192} {part:193}
{quanitity:195} {part:196}
{quantity:198} {part:199} {price:194}
{price:197}
{price:200}

Additional Front Chain {Additional Front Chain:183}{Additional Front Chain:185}{Additional Front Chain:186}{Additional Front Chain:220} {Additional Front Chain Price:184}

Additional Rear Chain {Additional Rear Chain:187}{Additional Rear Chain:188}{Additional Rear Chain:189}{Additional Rear Chain:221} {Additional Rear Chain Price:190}

10% Deposit: {10% Deposit:106}

Total: {Total Order Value:39}

Order Summary

Item Price

Product {Model Selection:14} {model price:128}

Chain Size {Chain Size:154}

Front Chain Selection {1204 front chain selections:216}{6m Front Chain Selection:26}{9m Front Chain Selection:64}{12m Front Chain Selection:65} {1204 front chain price:217}{6m front chain price:28}{9m front chain price:89}{12m front chain price:90}

Rear Chain Selection {1204 Rear Chain Selection:218}{6m Rear Chain Selection:30}{9m Rear Chain Selection:71}{12m Rear Chain Selection:72} {1204 Rear Chain Price:219}{6m rear chain price:32}{9m rear chain price:96}{12m rear chain price:97}

10% Deposit: {deposit:106}

Total: {Total:39}

Signature

By pressing the submit button you are sending this form to the Kelly Engineering 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.

Please note that 6m & 9m machines will ship framework fully assembled, with chain to be fitted on delivery.

12m machines will ship framework partially assembled with chain to be fitted on delivery.
Comments
This field is for validation purposes and should be left unchanged.

Machine & Chain Order Form

Dealer information

Customer Information

Product Information

Additional Products

Order Summary

Order Summary

Kelly

ПРОДУКЦІЯ

РЕСУРСИ

ПІДПИШІТЬСЯ НА НАШУ РОЗСИЛКУ

	Item	Price
Product	{Model Selection:14}	{model price:128}
Tow Hitch	{tow hitch:173}{tow hitch:174}{tow hitch:175}	{tow hitch price:176}{tow hitch price:177}{tow hitch price:178}{tow hitch price:215}
Brakes	{brakes:180}
Front Chain Selection	{1204 Front Chain Selection:216}{6m Front Chain Selection:26}{9m Front Chain Selection:64}{12m Front Chain Selection:65}	{1204 Front Chain Price:217}{6m front chain price:28}{9m front chain price:89}{12m front chain price:90}
Rear Chain Selection	{1204 Rear Chain Selection:218}{6m Rear Chain Selection:30}{9m Rear Chain Selection:71}{12m Rear Chain Selection:72}	{1204 Rear Chain Price:219}{6m rear chain price:32}{9m rear chain price:96}{12m rear chain price:97}
Spare Parts	{quantity:192} {part:193} {quanitity:195} {part:196} {quantity:198} {part:199}	{price:194} {price:197} {price:200}
Additional Front Chain	{Additional Front Chain:183}{Additional Front Chain:185}{Additional Front Chain:186}{Additional Front Chain:220}	{Additional Front Chain Price:184}
Additional Rear Chain	{Additional Rear Chain:187}{Additional Rear Chain:188}{Additional Rear Chain:189}{Additional Rear Chain:221}	{Additional Rear Chain Price:190}
10% Deposit:		{10% Deposit:106}
Total:		{Total Order Value:39}

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Machine & Chain Order Form

Dealer information

Customer Information

Product Information

Additional Products

Order Summary

Order Summary

Kelly

ПРОДУКЦІЯ

РЕСУРСИ

ПІДПИШІТЬСЯ НА НАШУ РОЗСИЛКУ

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