205 Huehl Road, Northbrook, IL 60062 • Phone: 1-800-548-GARD (4273) • Fax: 1-888-548-GARD (4273) • www.saftgard.com Audi e-tron PPE HVE Kit Order Form Please send this completed form to Saf-T-Gard’s Customer Service, via fax or email.Credit card payment accepted.
Instructions: To place an order for an Audi e-tron PPE HVE Kit, please fill out your contact information located below. Next, please fill out your preferred sizes in the yellow highlighted boxes for each sized...
205 Huehl Road, Northbrook, IL 60062 · Phone: 1-800-548-GARD (4273) · Fax: 1-888-548-GARD (4273) · www.saftgard.com Audi e-tron® PPE HVE Kit Order Form Instructions: To place an order for an Audi e-tron® PPE HVE Kit, please fill out your contact information located below. Next, please fill out your preferred sizes in the yellow highlighted boxes for each sized item in the table on pages 2-4. Please note that the actual pricing of each kit will vary depending on your selected sizes. Refer to page 5 for sizing details. Please send this completed form to Saf-T-Gard's Customer Service, via fax or email, or call to order. Credit card payment accepted. Fax: Toll Free: (888) 548-4273 or (847) 291-1610 Phone: (800) 548-4273 or (847) 291-1600 Email: CustomerService@Saftgard.com Contact Information: Contact Name:_____________________________ Dealership Name: _______________________________Dealer Code:_____________ Billing Address:___________________________________________________________________________________________________ Street Address City State Zip Shipping Address:_________________________________________________________________________________________________ Street Address City State Zip Phone Number:______________________________________ Email:______________________________________________________ Kit Contents One Complete Kit Contains all of the Items Below: 1 Lift Front Hood 1 Long Hood 1 Jacket 1 Pair of Pants 1 Lab Coat 1 Pair of Rubber Insulating Gloves 1 Pair of Cotton Glove Liners 1 Pair of Leather Protectors 1 Pair of Shoes Preferred Size Please Specify Your Preferred Size by Filling out the "Preferred Size" Column for the Following Items: Jacket Pants Lab Coat Rubber Insulating Gloves Leather Protectors Shoes Image Price Actual Price of Kit will Vary, Depending upon Your Selected Sizes Please send this completed form to Saf-T-Gard's Customer Service, via fax or email. Credit card payment accepted. Page 1 Fax: Toll Free: (888) 548-4273 or (847) 291-1610 Phone: (800) 548-4273 or (847) 291-1600 Email: CustomerService@Saftgard.com REMEMBER: Rubber insulating gloves must be retested every 6 months. For more information visit www.voltgard.com or click on this link for a retest order form: Rubber Insulating Products Testing Order Form 205 Huehl Road, Northbrook, IL 60062 · Phone: 1-800-548-GARD (4273) · Fax: 1-888-548-GARD (4273) · www.saftgard.com Audi e-tron® PPE HVE Kit Order Form Please fill out your preferred sizes in the yellow highlighted boxes for each sized item in the table below. Please note that the actual pricing of each kit will vary depending on your selected sizes. Refer to page 5 for sizing guide. Part Number SWH-20H3P Kit Contents' Descriptions CPA Arc-Rated 20 cal/cm2 Lift Front Hood with Hard Hat Included Anti-Fog & Anti-Scratch Coated Shield Meets ANSI Z87.1 Requirements Tested to ASTM F2187 Specifications Available Size(s) One Size Fits All Preferred Size N/A Image Price $275.00/each KCF-51 CPA CarbonX® 23 cal/cm2 FR Balaclava NFPA 70E Rated, 2-Ply, Knit Flared One Size Fits All N/A $36.50/each SWJ-20/SZ CPA Arc Flash 20 cal/cm2 35" Jacket Indura UltraSoft Fabric, Stand Up Collar w/ Velcro® Closure, Knit Wrists, Front Velcro® Closure, NFPA 70E Rated, Meets ASTM F1506 Requirements Select Size: S, M, L, XL, 2XL, 3XL or 4XL Sizing is Unisex Preferred Size: ____________ S-XL = 95.00/each 2XL = 104.50/each 3XL = 114.00/each 4XL = 123.50/each Please send this completed form to Saf-T-Gard's Customer Service, via fax or email. Credit card payment accepted. Page 2 Fax: Toll Free: (888) 548-4273 or (847) 291-1610 Phone: (800) 548-4273 or (847) 291-1600 Email: CustomerService@Saftgard.com REMEMBER: Rubber insulating gloves must be retested every 6 months. For more information visit www.voltgard.com or click on this link for a retest order form: Rubber Insulating Products Testing Order Form 205 Huehl Road, Northbrook, IL 60062 · Phone: 1-800-548-GARD (4273) · Fax: 1-888-548-GARD (4273) · www.saftgard.com Audi e-tron® PPE HVE Kit Order Form Part Number SWP-20/SZ Please fill out your preferred sizes in the yellow highlighted boxes for each sized item in the table below. Please note that the actual pricing of each kit will vary depending on your selected sizes. Refer to page 5 for sizing guide. Kit Contents' Descriptions CPA Arc Flash 20 cal/cm2 Pants Indura UltraSoft Fabric, Front Velcro® Closure, Belt Loops, and Leg Slits w/ Continuous Velcro® Closures, NFPA 70E Rated, Meets ASTM F1506 Requirements Available Size(s) Preferred Sizes Select Size: S, M, L, XL, 2XL, 3XL or 4XL Sizing is Unisex Preferred Size: ____________ Image Price S-XL = 90.00/pair 2XL = 99.00/pair 3XL = 108.00/pair 4XL = 117.00/pair SWC-43/SZ CPA Arc Flash 43 cal/cm2 50" Lab Coat Indura UltraSoft Fabric, Stand up Collar w/ Velcro® Closure, Front Velcro® Closure and Knit Wrists, NFPA 70E Rated Select Size: S, M, L, XL, 2XL or 3XL Sizing is Unisex Preferred Size: ____________ S-XL = 165.00/each 2XL = 181.50/each 3XL = 198.00/each 4XL = 214.50/each E-011R/SZ Salisbury 11" Red Class 0 Rubber Insulating Gloves (Max use 1000 Volts) Select Size: 7, 8, 8½, 9, 9½, 10, 10½, 11 or 12 Preferred Size: ____________ $60.00/pair Please send this completed form to Saf-T-Gard's Customer Service, via fax or email. Credit card payment accepted. Page 3 Fax: Toll Free: (888) 548-4273 or (847) 291-1610 Phone: (800) 548-4273 or (847) 291-1600 Email: CustomerService@Saftgard.com REMEMBER: Rubber insulating gloves must be retested every 6 months. For more information visit www.voltgard.com or click on this link for a retest order form: Rubber Insulating Products Testing Order Form Part Number 205 Huehl Road, Northbrook, IL 60062 · Phone: 1-800-548-GARD (4273) · Fax: 1-888-548-GARD (4273) · www.saftgard.com Audi e-tron® PPE HVE Kit Order Form Please fill out your preferred sizes in the yellow highlighted boxes for each sized item in the table below. Please note that the actual pricing of each kit will vary depending on your selected sizes. Refer to page 5 for sizing guide. Kit Contents' Descriptions Available Size(s) Preferred Sizes Image Price Voltgard® Cotton Glove Liners VG-10822 Reversible Fit, Medium Weight, Seamless One Size Fits All N/A Knit and Extra-Long Cuff $2.10/pair VLP-110/SZ Voltgard® Low-Voltage Leather Protector Gloves Grain Goatskin, Gunn Cut, Slip-On Cuff and Elastic Shirred Back, Dual Sized to Fit Over Half Sizes of Rubber Insulating Gloves Select Size: 7-7½, 8-8½, 9-9½, 10-10½, 11-11½ or 12 Preferred Size: ____________ OL11114/SZ Oliver by Honeywell Low Industrial Hiker Work Shoe Brown/Black Leather, EH-Rated, Steel Toe Select Size: 7, 7½, 8, 8½, 9, 9½, 10, 10½, 11, 11½, 12, 13 or 14 Preferred Size: ____________ $15.00/pair $97.00/pair Please send this completed form to Saf-T-Gard's Customer Service, via fax or email. Credit card payment accepted. Page 4 Fax: Toll Free: (888) 548-4273 or (847) 291-1610 Phone: (800) 548-4273 or (847) 291-1600 Email: CustomerService@Saftgard.com REMEMBER: Rubber insulating gloves must be retested every 6 months. For more information visit www.voltgard.com or click on this link for a retest order form: Rubber Insulating Products Testing Order Form 205 Huehl Road, Northbrook, IL 60062 · Phone: 1-800-548-GARD (4273) · Fax: 1-888-548-GARD (4273) · www.saftgard.com Audi e-tron® PPE HVE Kit Order Form Sizing Guide How to Determine What Size Rubber Insulating Glove to Order: Wrap a tape measure around your dominant hand just below the knuckles, not including the thumb. The measurement in inches is your numerical glove size (round up to the nearest half inch) i.e. A measurement of 8.25" would be a size 8½. Leather protectors are sized similarly to rubber insulating gloves. Leather protectors are dual sized to fit properly over half sizes. i.e. If you are a size 8 ½ in rubber insulating gloves, you would be an 8 in leather protector gloves, as a size 8 leather protector fits over a size 8 and a size 8 ½ rubber insulating gloves. How to Determine What Size Jacket, Lab Coat and Pants to Order: Please refer to the sizing chart to the left to determine the coverall size you will need. All garments are unisex. Please send this completed form to Saf-T-Gard's Customer Service, via fax or email. Credit card payment accepted. Page 5 Fax: Toll Free: (888) 548-4273 or (847) 291-1610 Phone: (800) 548-4273 or (847) 291-1600 Email: CustomerService@Saftgard.com REMEMBER: Rubber insulating gloves must be retested every 6 months. For more information visit www.voltgard.com or click on this link for a retest order form: Rubber Insulating Products Testing Order FormMicrosoft Word 2013