Trade-In Quote Request - Air Bag Check

In order to be considered for the 20% discount trade-in quote, please fill out the following form for Air Lifting Bags, Rescue Air Cushions, Rescue Struts Systems and Vehicle Stabilization Kits. The form will allow for up to five product entries. More than five? Submit the form again with the additional products.

Air Lifting Bags and Air Cushions must have a serial number on each. A picture of each product MUST be attached to Quote Request form (serial numbers MUST be clear on Air Bags and Cushions for consideration).

ALL fields are required.

Your Information

Your Name(Required)

Phone(Required)

Email(Required)

Emergency Service Agency Name(Required)

Emergency Service Agency Address(Required)

Purchase Product Information

Product 1 Brand(Required)

Product Size(Required)

Product 1 Quantity(Required)

Product 1 Paratech Description(Required)

Product 1 Description / Serial Number(Required)

Product 1 Part Number(Required)

Product 1 Paratech Item Number(Required)

Product Information

Product 1 Brand(Required)

Product 1 Size(Required)

Product 1 Quantity(Required)

Product 1 Description / Serial Number(Required)

Product 1 Part Number(Required)

Product 1 Paratech Item Number(Required)

Product 1 Paratech Description(Required)

Image(s)(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB, Max. files: 3.

Do you have an additional product to add?

Yes

Product 2 Information

Product 2 Brand(Required)

Product 2 Size(Required)

Product 2 Quantity(Required)

Product 2 Part Number(Required)

Product 2 Description / Serial Number(Required)

Product 2 Paratech Item Number(Required)

Product 2 Paratech Description(Required)

Image(s)(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB, Max. files: 3.

Do you have an additional product to add?

Yes

Product 3 Information

Product 3 Brand(Required)

Product 3 Size(Required)

Product 3 Quantity(Required)

Product 3 Part Number(Required)

Product 3 Description / Serial Number(Required)

Product 3 Paratech Item Number(Required)

Product 3 Paratech Description(Required)

Image(s)(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB, Max. files: 3.

Do you have an additional product to add?

Yes

Product 4 Information

Product 4 Brand(Required)

Product 4 Size(Required)

Product 4 Quantity(Required)

Product 4 Part Number(Required)

Product 4 Description / Serial Number(Required)

Product 4 Paratech Item Number(Required)

Product 4 Paratech Description(Required)

Image(s)(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB, Max. files: 3.

Do you have an additional product to add?

Yes

Product 5 Information

Product 5 Brand(Required)

Product 5 Size(Required)

Product 5 Quantity(Required)

Product 5 Part Number(Required)

Product 5 Description / Serial Number(Required)

Product 5 Paratech Item Number(Required)

Product 5 Paratech Description(Required)

Image(s)(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB, Max. files: 3.

Declarations

Declarations(Required)

If this request results in a trade-in, it is hereby declared that the above mentioned products will be destroyed upon receipt of the new Paratech products. Paratech reserves the right to collect all traded-in equipment.

Comments

This field is for validation purposes and should be left unchanged.