Hospitals

Order Form

Please fill out order form 

Copy and paste into an email to comtech2000cubmobile@yahoo.com

Please make sure cubmobile is in subject line.

Or print and fax to 419-459-4333

We must have this information to calculate shipping costs before we can give you a total.

Payment

We take personal checks ( we require a copy of the check by email or fax before releasing parts).

We also can take PayPal ( a $3.00 charge is added for using PayPal).

  Name :

  Address:

  City:

  State:

  Zip Code:

  Phone:

  Fax:

  Email:

Products

Cubmobile Wheel Kit                             $32.00 each                          Quantity_____

8" Wheel/tire with 3/8 bearings             $6.50 each                           Quantity _____

8" Wheel/tire with 1/2 bearings             $6.50 each                           Quantity _____

10"Wheel/tire with 1/2 bearings            $12.75 each                          Quantity_____

Spoke cover for 8" wheel/tire               $1.00 each                            Quantity_____

Hub caps for 3/8 hex head bolts             $1.00 each                           Quantity_____

Hub caps for 1/2 hex head bolts            $1.25 each                            Quantity_____