Product Order Request Form

Please fill this form out completely to ensure proper support and minimize response times.

Placing an Order

Contact Information

First Name:

Last Name:

Phone:

Have you ordered from us before?

Email:

Company Name:

Please put your name in this field if there is no attached company.

Order Information

Part Number:

Type in part number starting with "MB" to find parts more quickly.

Quantity:

Parts Needed By:

Subject to MaxBotix lead times and availability of the selected sensors.

Please visit our Sensor Selection Guide for help finding the right sensor. CLICK HERE

TOTAL PARTS

Billing Address

Billing Country

Billing Street

Billing City

Billing State/Province:

Billing Zip/Postal Code:

Shipping matches Billing Address:

Shipping Address

Shipping Country

Shipping Street

Shipping City

Shipping State/Province:

Shipping Zip/Postal Code:

Delivery Information

Payment Method:

PayPal Email Address:

Credit Card Form

Please print and complete this credit card form, and then fax the form to (888)380-3977.

Do NOT email the credit card form. [Link]

Alternatively, you can call us at 1-218-454-0766 with your credit card number.

Preferred Shipping Company:

USPS Notice:

If chosen on an order over $500, the cheapest UPS shipping method will be selected to ship your package.

Shipping Method:

NOTICE for UPS Worldwide Express

If UPS Express is not available to your location, UPS Worldwide Express Saver will be chosen instead.

Shipping Account Number:

DHL Notice:

If DHL is chosen, you must supply your DHL account number or we will be unable to process your order.

Shipping Account Number:

Additional Notes:

Upload PO (optional):

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Product Order Request Form

Placing an Order