Note: All Information, except Fax, is required to place an order.
Name:
Company:

Company Info: Ship To Same
Ship To Different (complete below)
Address: Ship To:
City: Address:
State: Zip: Country: City:
Phone: Ext.: State: Zip: Country:
Email:
Fax:

Purchase Order #
Job #/Project Name:
Duns Number:
Payment: Credit Approved by Lapeyre Stair
Credit Application (complete after submitting order form)
Prepayment (Check following)
Bill my VISA/Mastercard/American Express (call Lapeyre Stair with card info)

Shipping Instructions: All shipments common carrier truck - freight charge is the responsibility of customer).
FOR ALL CANADIAN SHIPMENTS - CUSTOMER MUST PROVIDE BROKER INFORMATION AT THE TIME ORDER IS PLACED.
Freight Charges should be: PREPAY and Add / Best Way
COLLECT
3RD PARTY
If Collect or 3rd Party, specify CARRIER
If 3rd Party, specify BILL TO





FIXED STAIRS: Please specify the following:
* Minimum and Maximum heights apply -- Click here for details
Qty.
Stair Angle
Material & FinishHandrail
*Stair Height (inches)

PLATFORMS: Please specify the following:
Qty.
DescriptionMaterial & Finish
Associated Stair Angle
Options (N/A for Crossovers)
56
68
56
68

MOBILE STAIRS: Please specify the following
Qty.
Height
Material & Finish

Safety Gates: Please specify the following
Qty.
Material & Finish


Crossover Braces: Please specify the following
Qty.
Material & Finish

Comments: