To submit this form, you can email it to the designated address provided above. Alternatively, you may fax it directly using the numbers listed. For physical submissions, please send the completed form to the address included on the document.

Please note that the pricing and availability are effective from August 21, 2019. For future updates in pricing or options, check back periodically. Form submissions must adhere to any specific deadlines set by the company.

The purpose of this form is to facilitate the order of Ultra Low Maxx Power Positioning Accessories effectively for dealers and clients. It ensures that all required specifications are captured accurately for the precise fulfillment of orders. By providing a structured format, it streamlines the ordering process, allowing for efficient service delivery.

• 1. Dealer Name: The name of the dealer ordering the accessories.
• 2. Dealer Account Number: The unique account number for the dealer.
• 3. PO #: The purchase order number associated with the order.
• 4. Tag: Any specific tag or reference for the order.

Failure to submit this form can lead to delays in obtaining necessary equipment. Incomplete orders may result in the inability to process requests promptly. It is crucial to ensure all parts are filled out accurately.

• Incomplete Orders: If sections are missing, the order cannot be processed.
• Delayed Shipping: Missing information may extend shipping timelines.
• Unapproved Orders: Orders not meeting the criteria may be rejected.

• 1. Ordering Accessories: Use this form to procure accessories for mobility solutions.
• 2. Client Specifications: This form helps capture unique client needs.
• 3. Bulk Orders: Dealers may use this form for large orders to streamline processes.