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 InformationDealership 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Shipping Address* Shipping Address Same As Billing Address? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is this machine for stock or retail?StockRetailCustomer InformationCustomer 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Product InformationModel SelectionNoneChains Only20063009401246146218HDX12X SmootherChain SizeNone20063009401246146218HDX12X Smoother45List PriceTire OptionStandard 11.5/80-15.3Tire Option400/55/22.5 Flotation BKTTire Option400/55/22.5 Flotation BKTTire Option15.5 x 242006 Front Chain SelectionNoneSpike Disc Chain SD49/27/5 2006W36/25/7 2006CL1 Disc Chain CL47/35/7 2006CL75/25/8 CL2 2006K4/50/25/63 20063009 Front Chain SelectionNoneSD49/27/5 Spike Disc 3009W36/25/7 3009CL1 Disc Chain CL47/35/7 3009CL75/25/8 CL2 3009K4/50/25/63 30094012 Front Chain SelectionNoneSD49/27/5 Spike Disc 4012W36/25/7 4012CL47/35/7 (CL1) 4012CL75/25/8 CL2 401245 Front Chain SelectionNoneSD49/27/5 Spike Disc 45W36/25/7 45CL47/35/7 (CL1) 45CL75/25/8 CL2 45K4/50/25/63 454614 Front Chain SelectionNoneSD49/27/5 Spike DiscW36/25/7CL47/35/7 (CL1)CL75/25/8 CL2K4/50/25/636218HDX Front Chain SelectionNoneSD49/27/5 6218HDXW36/25/7 6218HDXCL47/35/7 (CL1) 6218HDXCL75/25/8 CL2 6218HDXK4/50/25/63 6218HDX12X Smoother Front Chain SelectionNoneSD49/27/5 12X SmootherW36/25/7 12X SmootherCL47/35/7 (CL1) 12X SmootherK4/50/25/63 12X SmootherList PriceList PriceList PriceList PriceList PriceList PriceList Price When ordering CL75/25/8 CL2 disc chain, CL47/35/7 CL1 disc chain is required CL47/35/7 Front4 DiscsNoneCL47/35/7 Front7 DiscsNoneSupplemental Front Chain PriceSupplemental Front Chain PriceSupplemental Front Chain PriceSupplemental Front Chain PriceSupplemental Front Chain PriceSupplemental Front Chain PriceFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeFront Chain SurchargeHiddenFront Chain Surcharge2006 Rear Chain SelectionNoneSD49/27/5 Spike Disc 2006W36/25/7 2006CL47/35/7 (CL1) 2006CL75/25/8 CL2 2006K4/50/25/63 20063009 Rear Chain SelectionNoneSD49/27/5 Spike Disc 3009W36/25/7 3009CL47/35/7 (CL1) 3009CL75/25/8 CL2 3009K4/50/25/63 30094012 Rear Chain SelectionNoneSD49/27/5 Spike Disc 4012W36/25/7 4012CL47/35/7 (CL1) 4012CL75/25/8 CL2 4012K4/50/25/63 401245 Rear Chain SelectionNoneSD49/27/5 Spike Disc 45W36/25/7 45CL47/35/7 (CL1) 45CL75/25/8 CL2 45K4/50/25/63 454614 Rear Chain SelectionNoneSD49/27/5 Spike DiscW36/25/7CL47/35/7 (CL1)CL75/25/8 CL2K4/50/25/636218HDX Rear Chain SelectionNoneSD49/27/5 Spike Disc 6218HDXW36/25/7 6218HDXCL47/35/7 6218HDXCL75/25/8 CL2 6218HDXK4/50/25/63 6218HDX12X Smoother Rear Chain SelectionNoneSD49/27/5 Spike Disc 12XW36/25/7 12XCL47/35/7 12XK4/50/25/63 12XList PriceList PriceList PriceList PriceList PriceList PriceList PriceCL47/35/7 Rear4 DiscsNoneCL47/35/7 Rear17 DiscsNoneCL47/35/7 Rear18 DiscsNoneCL47/35/7 Rear20 DiscsNoneSupplemental Rear Chain PriceSupplemental Rear Chain PriceSupplemental Rear Chain PriceSupplemental Rear Chain PriceSupplemental Rear Chain PriceSupplemental Rear Chain PriceRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeRear Chain SurchargeHiddenRear Chain SurchargeOuter wing dual wheel optionNone1 Set outer wing dual wheelsOuter wing dual wheel optionStandardHitch optionNone15mm ring feeder hitchHitch optionNoneBall Socket Hitch Cat.4 2” Pin Size (1-1/2” Bushing)Ball Socket Hitch Cat. 5 2-1/2” to 2-3/4” Pin Size (2-1/2” Bushing)Hitch optionNoneBall Socket Hitch Cat. 5 2-1/2” to 2-3/4” Pin Size (2-1/2” Bushing)Cover crop seeding optionNoneIntegrated 80cu ft Seeder for One Pass Cover Crop SeedingList PriceAdditional ProductsTick 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 ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Front ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Front ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Front ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Front ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Front ChainNoneSD49/27/5W36/25/7CL47/35/7K4/50/25/63PriceAdditional Rear ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Rear ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Rear ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Rear ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Rear ChainNoneSD49/27/5W36/25/7CL47/35/7CL75/25/8K4/50/25/63Additional Rear ChainNoneSD49/27/5W36/25/7CL47/35/7K4/50/25/63PriceOther instructions relating to this order Estimated Freight CostQuoted FreightFreight to be invoiced separatelyTotal Order ValueDiscounts Dealer discount: 25% Hidden Paid within terms: 10% HiddenIs there an additional discount on this machine? Yes Discounted Product Discount ValueApproved By TotalInitial TotalSurcharge TotalFinal 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.