ORDER FORM 5 West Olive Plaza • Scranton, PA 18508 (1-866) 388-2102 • Phone or Fax: (570) 347-3878 HAND TRUCK TRANSPORT SOLUTIONS www.handtrucksystems.com • www.handtruckcarrier.com Shipping Method Shipping Address (Please Print Clearly) Attention:____________________________________________________Title:______________ ❑ UPS Next Day Air Company:_____________________________________________________________________ ❑ UPS 2nd Day Air Address:___________________________________________________M/S:_____________ ❑ UPS Ground City:_____________________________________Street:___________________________ ❑ FedEx Zip:_____________________________________Country:_________________________ ❑ DHL Phone: ( )________________________________Fax: ( )_________________________ ❑ Common Carrier E-Mail: _______________________________________________________________________ ❑ Other____________________________ Purchase Order Number:_________________________________________________________ Please provide the year, make and model of vehicle and truck body manufacturer. Special Instructions Vehicle: Year:__________________ Make:__________________ Model: _________________ ___________________________________ Body/Van: Year:__________________ Make:__________________ Model: ________________ ❑ ❑ ❑ ___________________________________ Vehicle Fuse Block ATO Standard ATM Mini Fuse Inline Fuse / M2 ___________________________________ Billing Address (If Different than Shipping Address) ___________________________________ Company:_____________________________________________________________________ ___________________________________ Name:______________________________________________________Title:______________ ___________________________________ Address:__________________________________________________M/S:_____________ ___________________________________ City:_____________________________________Street:___________________________ ___________________________________ Zip:_____________________________________Country:_________________________ ___________________________________ Phone: ( )________________________________Fax: ( )_________________________ Salesperson: Date of Order: Payment Terms: Date of Order Shipped: Method of Shipment: FOB Point: Invoice Number: Invoice Date: Order Number: Item No. Qty. Description Color Price Each Amount HTS-10T Tilt Mount (Front Mount) $519.00 HTS-20S Swing Mount (Rear Mount) $739.00 HTS-30D Direct Mount (Rear Mount) $519.00 HTS-AP Universal Adapter Plate $45.00 MC - 20 30 40 Micro-Cable Extention (30 ft. or 40 ft.) Type of Payment Quantity Discount ❑ Company Check or Money Order Enclosed Shipping & Handling ❑ Master card ❑ Discover ❑ American Express ❑ Visa Sub Total Card No.______________________________________Exp. Date ______/______/_____ PA Tax Rate - 6% Tax Signature._________________________________________Date______/______/______ Credit/Deposit Total Please fill out this CUSTOMER INFORMATION SURVEY, so we may serve you better. SURVEY INFORMATION WILL NOT BE SHARED WITH OTHER COMPANIES. Would you like to have our HTS representative contact your company? ❑ Yes, Please have HTS representative call or schedule an appointment. ❑ No Thank you, it is not necessary to call or visit at this time. Company Delivery Business: Number of Hand Trucks:__________ Truck Chassis Manufacturer: ____ Beverage Distributor Hand Truck Frame Design: ____ Dodge ____ Ford ____ Food Service Routes ____ Extruded Aluminum Frame ____ Freightliner M2 ____ GM (Cheverolet/GMC) ____ Parcel / Package Delivery ____ Tubular (weld) Aluminum ____ Hino ____ International (Navistar) ____ Freight Industry / LTL Carrier ____ Tubular (weld) Steel ____ Isuzu ____ Iveco ____ Armored Car Services ____ Extruded Aluminum and Magnesium ____ Kenworth 7300 ____ Mack Truck ____ Battery Supply Distributor ____ Polymer (plastic) Nylon / Composite ____ Mercedes ____ Mitsubishi Fuso ____ Propane / Gas Delivery ____ Other/Custom Design_____________ ____ Peterbilt ____ Renault ____ Snacks / Vending Machines ____ Sterling ____ Scania ____ Office Supply / Paper Delivery Number of Fleet Vehicles:_________ ____ UD Trucks ____ Volvo ____ Photo Supply Delivery Body Type: ____ Ashok Leyland ____ PACCAR ____ Document Destruction ____ Box Van ____ Beverage Side-loaded ____ BMC UK ____ Other_________________ ____ Medical Waste Pick-Up ____ Step Van ____ Utility Bay Roll-up ____ Medical & Dental Supply ____ Sprinter Van ____ Commercial Van Hand Truck Manufacturer: ____ Bakery Supply Delivery ____ Semi-Trailer ____ Utility Van ____ B & P Manufacturing / Liberator / Challenger ____ Clarke ____ Chemical Supply Company ____ Stake Body ____ Mini Van ____ Hamilton Caster / Ultra-Lite ____ Fairbanks ____ Electrical / Plumbing Supply ____ Flat Bed ____ Other_____________ ____ Magliner / Gemini / Liftkar / Axlom ____ Dayton ____ Furniture & Appliance Delivery ____ Ford Van ____ Chevy Van ____ Honeyman Hand Trucks ____ Morse Metal Products ____ Automotive Parts Delivery ____ Lockwood Manufacturing ____ Magcoa / Customized B&P ____ Florist Supply Delivery Truck Body Manufacturer / Refurbish Companies: ____ Harper Trucks ____ Purcel Enterprises / Grizzly ____ Rental Trucks / Moving Company ____ Centennial ____ Group Hesse ____ Wesco / Cobra / Spartan / Mighty-Lite ____ Qingdao Gaotain / Hank Trucks ____ Pharmaceutical Products Delivery ____ Hackney & Sons ____ Mickey Bodies ____ RWM Caster ____ Yewe Yih Enterprises ____ Landscape Nursery & Plant Shops ____ Triple B Bodies ____ Utilimaster ____ Valley Craft / Dura-Lite ____ Expresso ____ Uniform & Linen Supply ____ Johnson Bodies ____ Morgan / Olson ____ Gleason / Milwaukee ____ Clayton ____ Vacation Resort / Hotel Logistics ____ Beverage Body ____ Drake ____ Ta Yeou ____ Carmeccanica / Italy ____ Home Improvement / Contractors ____ Kogler ____ Betten Trucks ____ Yee Shiuann ____ Sano / Liftkar / Austria ____ Pool Maintenance Supply ____ Lynch ____ ITB Bodies ____ LL King Hand Trucks ____ MECO ____ Janitorial Services / Cleaning Supply ____ Jay Hessco ____ Bucks Trucks ____ Dutro ____ Akro-Mils ____ Newspaper / Magazine Delivery ____ Kidron ____ Grumman ____ EBCO ____ Lyon ____ Other_______________________ ____ Workhorse ____ ABC ____ Cascade ____ Vestil Manufacturing ____ Reading ____ Southern Truck ____ Daisy ____ LiftRite Hand Truck Transport Method: ____ Cambli ____ Bay Bridge ____ PowerMate ____ Nalpak / Customized Magliner ____ Rubber Straps / Bungee Cords ____ Marathon ____ Rockport ____ Carrelli / Italy ____ Leverage ____ Chain & Padlock / Chain w/Spring ____ Coastal Industries ____ Supreme ____ OleRoller Hand Trucks ____ Other___________________ ____ OEM Lock-Bar / Custom Hasp Bracket ____ UCBC ____ Unicell ____ Lien Chief ____ OEM Slide-Pins / Twist-Bar ____ Quality Truck ____ Other_____________ ____ Vehicle Interior Storage / Shelved ____ Other _______________________ Color Select Option: Color Select Option allows the customer to closely match the HTS unit to the color of your truck body or company brand logo when selecting from our (6) six different UV stabilized polymer colors. A ten (10) unit minimum order is required to purchase Color Select. Standard HTS units are Black. Custom colors are abailable upon special request, a fifty (50) unit quantity order is required. Code Color Type Finish Standard-BL Black (Standard) Dark Jet Black Mat CS-RD Red Coca Cola Red Mat CS-GN Green Interstate Battery / Sprite Mat CS-BE Blue Pepsi Cola Blue Mat CS-YW Yellow DHL / Snapple Yellow Mat CS-BN Brown UPS Brown Mat Please Note: Most HTS rear installations will require a 20 ft. or 30 ft. Micro-Cable extension wire. 4-6 bay 134” 20 ft. 8-10 Bay 136”-224” 30 ft. 10-12 Bay 238”-297” 30 ft. All Bay Trailers 40 ft. Remote Keyless Entry System and Ignition Interrupt Kits may be ordered and/or purchased separately. The HTS-10T and HTS-30D units require a flat vertical mounting surface, or an HTS adapter plate. Model Description Weight List Price Retail Price HTS-10T Tilt Mount (Front Mount) 25 lbs. (10.4 kg) $599.00 $519.00 HTS-20S Swing Mount (Rear Mount) 60 lbs. (15.4 kg) $789.00 $739.00 HTS-30D Direct Mount (Rear Mount) 23 lbs. (9.0 kg) $599.00 $519.00 HTS-AP Universal Adaptor Plate 8 lb. $55.00 $45.00 CS-Color Color Select Option --------- $35.00 $25.00 MC-20/30 Micro-Cable 20ft. or 3 0ft. 8.4 oz. (0.24 kg) $45.00 $35.00 MC-40 Micro-Cable 40ft. Extension 8.8 oz. (0.25 kg) $50.00 $40.00 RE-60 Remote Keyless Entry 3.6 lbs. (0.10 kg) $70.00 $65.00 VI-70 Vehicle Ignition Interrupt Kit 12.8 oz. (0.36 kg) $45.00 $25.00 TC-90 Tilt Converstion Kit 7.2 lbs. (0.20 kg) $69.00 $50.00 All shipments are FOB, Union, NJ, USA. Unless instructed, we reserve the right to package and ship your order in the most economical way. Orders of 1-10 units will be shipped by UPS, FedEx or DHL, orders 10 units or more may be palletized and shipped by LTL common carrier. Please allow 6-8 weeks for delivery. Special custom orders or high volume orders may take longer; consult your local HTS Systems dis- tributor or regional sales representative for additional information. Please contact our customer service center at (570) 342-2102 between the hours of 9 am to 5 pm EST, Monday thru Friday. Contact our corporate office toll free at 1-866-388-2102. Complete customer satisfaction is our goal. Thank you for trusting HTS Systems Lock N Roll, LLC to solve your Hand Truck Transportation and Safety needs..