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Customer Information
First Name:   
Last Name:   
Phone Number:  
Fax Number:  
Company Name:  
Address 1:  
Address 2:  
City:  
State/Providence:  
Postal Code:  

 

Billing Information
Bill to
(if different than Company Address):		  
Address 1:  
Address 2:  
City:  
State/ Providence:  
Postal Code:  
Phone Number:  
Fax Number:  
Contact Name:  

 

Shipping Information
Ship to
(if different than Company Address):		  
Address 1:  
Address 2:  
City:  
State/ Providence:  
Postal Code:  
Phone Number:  
Fax Number:  
Contact Name:  
Carrier of Choice:  
Note: All UPS shipments are at Customer's risk, we will not be responsible for lost or damaged freight handled by UPS.
Account #:   

Ship by Ground 2nd Day Next Day Fastest Call for shipping Instructions

 

Motor Information

Note: The PO Dollars value allows us to continue working on your repair if the quote is less than the PO Dollars.

If the quote is less than the PO Dollars value we will send you a quotation that is marked Pre-Approved.

This quote is to allow you to adjust your PO to the actual repair costs. If the quote is greater than the PO Dollar value, you will be sent a quotation and all work will stop on your repair until approval is received.

After tear down, a NO CHARGE EVALUATION of the repair will be done by our repair planning group to come up with the best pricing available for your repair.

IP67 Sealing starts at $325.00 plus the cost of new bearings and seals.

Please review our warranty Policy for more information.

Every item must have a Part Number, enter "Unknown" if the actual part number is not known.

 

 
Item 1
*Part Number Serial Number *Purchase Order PO Dollars
(US, Min. $90)		 EMERGENCY!
($100. ea)		 IP67 Seal Warranty

YES NO
YES NO
YES NO
Comments:
Item 2
Part Number Serial Number Purchase Order PO Dollars
(US, Min. $90) 		EMERGENCY!
($100. ea) 		IP67 Seal Warranty

YES NO
YES NO
YES NO
Comments:
Item 3
Part Number Serial Number Purchase Order PO Dollars
(US, Min. $90) 		EMERGENCY!
($100. ea) 		IP67 Seal Warranty

YES NO
YES NO
YES NO
Comments:
Item 4
Part Number Serial Number Purchase Order PO Dollars
(US, Min. $90)		 EMERGENCY!
($100. ea)		 IP67 Seal Warranty

YES NO
YES NO
YES NO
Comments:
Item 5
Part Number Serial Number Purchase Order PO Dollars
(US, Min. $90)		 EMERGENCY!
($100. ea)		 IP67 Seal Warranty

YES NO
YES NO
YES NO
Comments:

 

         If you want this order to Bill to a 2nd party, click here and double check the information.
         If you want this order to Ship to a 2nd or 3rd party, click here and double check the information.

 

 

Please only click on the Send Request button once, since there may be some delay.