Country Eagle Inflator and Accessory Order Form

Inflator & Options	Qty
6 HP 24 inch Inflator	______	$_____________
9 HP 30 inch Inflator	______	$_____________
Electric Start 9 HP Inflator	______	$_____________
Step Individual	______	$_____________
Pair of Steps Burner Box Holder	______	$_____________
Sub-Total		$_____________
50% Deposit required for order		$_____________
Balance Due		$_____________
Inflator Color: Red, Blue, Yellow, Black, White, Green
All prices F.O.B. Bentonville, AR.

CUSTOMER Name ________________________ Address ______________________ City_______ST______ Zip _______ Phone_________ Fax ___________ Email_________________________ Signature______________________ Date________________

Print and email form to: Darrell Weiland, President 2280 West Centerton Blvd Centerton, AR 72719 Phone: (479)366-2286 jdweiland@cox.net