Company Name
Date 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2011 2012 2013 2014 2015
P.O.
Ordered By
Billing Address
City
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Zip code
Same as Billing Address Shipping Address
Phone
Fax
Email
Vehicle Year
Make
Model
Type of Driver's Seat OEM Factory Power Seat OEM Factory Manual Seat
Type of Passenger's Seat OEM Factory Power Seat OEM Factory Manual Seat
Type of Ramp In-floor Ramp Folding Ramp None
Conversion By
Conversion Type
Year of Conversion
Interior Color Gray Tan
L41 Leadership Series: 6 Way for Non-Lowered Floor Full Size Vans Driver Passenger Comfort Safe Footrest Yes No
LS51 Leadership Series: 6 Way for Lowered Floor Full Size Vans Driver Passenger Decorative Cover for LS51 Yes No
L71 Leadership Series: 4 Way for Numerous Non-Lowered Floor Applications Driver Passenger Comfort Safe Footrest Yes No
L73 Leadership Series: 4 Way for Numerous Non-Lowered Floor Applications (Slide & Swivel Only) Driver Passenger
Powder Coat Gray (standard) Tan (additional fee)
1/2" Spacer Tubes
2" Spacer Tubes
3" Spacer Tubes
Handheld Pendant
180° Swivel
Installation Kit for L71 & L73 (Venture/Uplander)
Spare Carpet None Gray Tan
Spray Paint None Gray Tan
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