Machine And Chains Order Form

Machine And Chain Order Form

Date*
MM slash DD slash YYYY
Required Ship Date*
MM slash DD slash YYYY
Rep Reference Number*
Representative Company*
Representative Name*
First Last
Representative Email*
Dealer Information
Dealership Name*
Salesperson Name*
Dealer Email Address*
Dealer Contact Number*
Terms*
Payment terms greater than 15 days are subject to a current credit application approval.
- 15 days
- 60 days
- 90 days
Invoice Email Address*
Dealer Order Number*
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping Address*
Shipping Address Same As Billing Address?

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is this machine for stock or retail?
Customer Information
Customer information will only be used by Kelly to contact our customers directly for product and service improvement and warranty issues. We do not share our data with other companies.
Customer Name
First Last
Customer Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Product Information
Model Selection
Chain Size
List Price
Tire Option
Tire Option
Tire Option
Tire Option
2006 Front Chain Selection
3009 Front Chain Selection
4012 Front Chain Selection
45 Front Chain Selection
4614 Front Chain Selection
6218HDX Front Chain Selection
12X Smoother Front Chain Selection
List Price
List Price
List Price
List Price
List Price
List Price
List Price
When ordering CL75/25/8 CL2 disc chain, CL47/35/7 CL1 disc chain is required
CL47/35/7 Front
CL47/35/7 Front
Supplemental Front Chain Price
Supplemental Front Chain Price
Supplemental Front Chain Price
Supplemental Front Chain Price
Supplemental Front Chain Price
Supplemental Front Chain Price
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Front Chain Surcharge
Hidden
Front Chain Surcharge
2006 Rear Chain Selection
3009 Rear Chain Selection
4012 Rear Chain Selection
45 Rear Chain Selection
4614 Rear Chain Selection
6218HDX Rear Chain Selection
12X Smoother Rear Chain Selection
List Price
List Price
List Price
List Price
List Price
List Price
List Price
CL47/35/7 Rear
CL47/35/7 Rear
CL47/35/7 Rear
CL47/35/7 Rear
Supplemental Rear Chain Price
Supplemental Rear Chain Price
Supplemental Rear Chain Price
Supplemental Rear Chain Price
Supplemental Rear Chain Price
Supplemental Rear Chain Price
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Rear Chain Surcharge
Hidden
Rear Chain Surcharge
Outer wing dual wheel option
Outer wing dual wheel option
Hitch option
Hitch option
Hitch option
Cover crop seeding option
List Price
Additional Products
Tick which additional products you require
- CL2 Changeover jig fixture 0810-CL2PJA
- Standard 11.5/80-15.3 tire
- Standard 14-17 10 Ply titan loader lagged tire
- 14L-16.1 ply implement ribbed tire
- 400/60/22.5 flotation BKT tire
- 6218HDX lug tire 15.5/80/248STR
- Additional Chain
Additional Front Chain
Additional Front 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
Additional Rear Chain
Additional Rear Chain
Price
Other instructions relating to this order
Estimated Freight Cost
Quoted Freight
Freight to be invoiced separately
Total Order Value
Discounts
Dealer discount: 25%
Hidden
Paid within terms: 10%
Hidden
Is there an additional discount on this machine?
- Yes
Discounted Product
Discount Value
Approved By
Total
Initial Total
Surcharge Total
Final Total

Order Summary

	Item	Price
Product	{Model Selection:14}	{model price:128}
Tyre Option	{Tyres Standard 30 foot:111}{Tyres Standard 40 foot:112}{Tyres Standard 45 foot:113}{Model 46 tyres:143}{Model 46 dual wheel:145}{Model 50 Tyres:116}{Model 60CT Tyres:119}{60CT dual wheel:135}{62HDX dual wheel:138}{62HDX dual wheel floatation:139}	{Tyres Standard 30 foot Price:129}{Price:131}{Price:132}{Price:142}{Price:140}
Front Chain Selection	{6m Front Chain Selection:26}{30ft Front Chain Selection:64}{40ft Front Chain Selection:65}{Model 46 Front Chain Selection:146}{60CT Front Chain Selection:68}{62HDX Front Chain Selection:69}{80ft Front Chain Selection:70}	{Price:28}{Price:89}{Price:90}{Price:147}{Price:93}{Price:94}{Price:95}
Rear Chain Selection	{6m Rear Chain Selection:30}{30ft Rear Chain Selection:71}{40ft Rear Chain Selection:72}{Model 46 Rear Chain Selection:148}{60CT Rear Chain Selection:75}{62HDX Rear Chain Selection:76}{80ft Rear Chain Selection:77}	{Price:32}{Price:96}{Price:97}{Price:149}{Price:102}{Price:101}
Sub Total:		{Sub Total:39}
Discount:		{Discount Total:106}
Total Before GST:		{Pre GST Total:107}
GST:		{GST:156}
Total:		{Total:157}

Order Summary

	Item	Price
Chain Size	{Chain Size:120}
Front Chain Selection	{20ft Front Chain Selection:39} {30ft Front Chain Selection:67} {40ft Front Chain Selection:69} {45ft Front Chain Selection:68} {Model 46 Front Chain Selection:132} {62HDX Front Chain Selection:70}	{list price:40} {list price:103} {list price:104} {list price:105} {list price:133} {list price:106}
Rear Chain Selection	{20ft Rear Chain Selection:42} {30ft Rear Chain Selection:71} {40ft Rear Chain Selection:72} {45ft Rear Chain Selection:73} {Model 46 Rear Chain Selection:134} {62HDX Rear Chain Selection:74}	{20ft rear chain price:44} {30ft rear chain price:107} {40ft rear chain price:108} {45ft rear chain price:109} {45ft rear chain price:135} {62HDX rear chain price:110}
Supplemental Chain Option (front)	{20 CL47/35/7 Front:149} {30-62 CL47/35/7 Front:167}	{Supplemental Front Chain Price:151} {Supplemental Front Chain Price:157} {Supplemental Front Chain Price:158} {Supplemental Front Chain Price:159} {Supplemental Front Chain Price:160} {Supplemental Front Chain Price:161}
Supplemental Chain Option (rear)	{20 CL47/35/7 Rear:150} {30 CL47/35/7 Rear:168} {40 45 CL47/35/7 Rear:169} {46 62 CL47/35/7 Rear:170}	{Supplemental Rear Chain Price:156} {Supplemental Rear Chain Price:162} {Supplemental Rear Chain Price:163} {Supplemental Rear Chain Price:164} {Supplemental Rear Chain Price:165} {Supplemental Rear Chain Price:166}
Sub Total:		{Number:54}
Sub Total:		{Number:54}
30 Day Discount percent:		{Number:113}
15 Day Discount percent:		{Number:174}
Additional Discount:		{Number:205}
Discounted Total:		{Number:96}
Surcharge:		{Number:200}
Total:		{Number:201}
Est. Freight Cost:		{Number:276}

By pressing the submit button you are sending this form the dealer to approve and sign.

Machine And Chain Order Form

Dealer Information

Customer Information

Product Information

Additional Products

Other instructions relating to this order

Estimated Freight Cost

Total Order Value

Discounts

Total

Order Summary

Order Summary

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