Microlift Hybrid Pallet Jack Request

Microlift RFQ/Order Form

Hybrid Pallet Jack
Company Name
Requester

First NameLast Name
Requester E-mail
Requester Number

Area CodePhone Number
Are you an existing or new customer?

Existing Customer (Skip to page 2)New Customer / Prospect
Billing Address

Street Address

Street Address Line 2

CityState

Zip Code

I would like to

OrderQuote OnlyCall me to discuss in more detailOther
ET15MH 3,300lb Capacity Manual Lift Pricing

Qty 1 - 3 = $1688.00 ea.Qty 4 - 6 = $1628.90 ea.Qty 7 - 9 = $1603.60 ea.Qty 10 - 12 = $1569.84 ea.13+ RFQ
ET15MH Order Qty
Extra Battery Quantity $338.00 Each
Send Pricing for these options

4,400lb capacityElectric LiftScaleFreezer PrepStainless Steel
Quantity for above options:
Shipping Options

Will Call (Irwindale, CA 91706)Local Delivery $75.005 or more Free Local DeliveryFreight Quote Request
PO Number
We will email a formal quote for approval

The email confirmation you receive from this form is not the formal quote.
Ship To:

Shipping Address is same as billing addressShip to different location belowOther
Shipping Contact

First NameLast Name
Shipping Contact Email
example@example.com
Shipping Contact Number

Area CodePhone Number
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Additional Requests
Should be Empty:

Microlift RFQ/Order Form