| Sold To : | PO # | Ship To : (if different) |
| Co Name (if applicable) : | Co Name (if applicable) : |
| Name : | Name : |
| Address : | Address : |
| City : | City : |
| State/Zip Code : | State/Zip Code : |
| Daytime Phone : | Daytime Phone : |
| Fax : | Fax : |
| E-mail : | E-mail : |
| Qty. | |
|
|
| E-Z Cabinet Lift - 12" Model | 695.00 | ||
| E-Z Cabinet Lift - 24" Model | 795.00 | ||
| E-Z TV Lift - Standard Model | 795.00 | ||
| E-Z TV Lift - Fireplace Model | 895.00 | ||
| Extension tube for 9 or 10 foot high ceilings | 40.00 | ||
| E-Z Frame Spreader | 395.00 |
| |
||||
|---|---|---|---|---|
| Qty. | Model(s) | West - AR, AZ, CA, CO, IA, ID, KS, LA, MO, MT, ND, NE, NM, NV, OK, OR, SD, TX, UT, WA, WY | East - AL, CT, DC, DE, FL, GA, IL, IN, KY, MA, MD, ME, MI, MN, MS, NC, NH, NJ, NY, OH, PA, RI, SC, TN, VA, VT, WI, WV | |
| EZ Cabinet Lifts, EZ TV Lifts | 90.00 | 60.00 | ||
| EZ Door Frame Spreader | 15.00 | 15.00 | ||
| Extension Tubes | 10.00 | 10.00 | ||
| PAID BY : (Check One) | Credit Card Info (if applicable) | ||
| [ ] Check | Name on Card : | Total Amount | $ |
| [ ] Money Order | Card # : | CVV2 #: | |
| [ ] Master Card | Expiration Date : | PA Add 6% Tax | $ |
| [ ] Visa Card | Signature | GRAND TOTAL | $ |
Prices are subject to change without notice.