694 West Shore Drive Acton, Maine 04001

	Home ADA 1000 PBA 1000 Order Contact Us     Phone: (207)232-0321 Fax: (207)636-3747		Product Ordering Please select the product configurations you would like, and fill out the form below to place your order/request for quote. You can make multiple product selections by using the multiple sections (Product One, Two, etc..) below. Note: You must put in a valid e-mail address to use this form. Invalid addresses will not be sent. Order/Quote Request: Order Quote P.O. Number: Product One Pedestrian Button Type -None Selected- A.D.A. 2" Plunger (Americans W/Disability Act Approved) P.B.A. Original Hooded Style P.B.A. 2" Hooded Style with a 2" A.D.A. Plunger Switch Quantity One: Legend -None Selected- Push Button Wait For Walk Signal No Arrow Push Button Wait For Walk Signal Left Arrow Push Button Wait For Walk Signal Right Arrow Push Button Wait For Walk Signal Dual Arrow International Symbol No Arrow International Symbol Left Arrow International Symbol Right Arrow International Symbol Dual Arrow International Symbol Upside Down Cross With Caution Blank Signal Pole Mounting -None Selected- 4" Pole M.A. Mast Arm Flat Back Color Combinations- Plaques & Legends -None Selected- Silver Plaque/Black Legend Black Plaque/White Legend Other (Please Specify below) Special Request Items -None Selected- 2 Inch Plunger & Switch Chrome Switch & Face Nut Weatherproof Rubber Covered Switch 9/12 Inch Plaque instead of 5/7 Inch Product Two Pedestrian Button Type -None Selected- A.D.A. 2" Plunger (Americans W/Disability Act Approved) P.B.A. Original Hooded Style P.B.A. 2" Hooded Style with a 2" A.D.A. Plunger Switch Quantity Two: Legend -None Selected- Push Button Wait For Walk Signal No Arrow Push Button Wait For Walk Signal Left Arrow Push Button Wait For Walk Signal Right Arrow Push Button Wait For Walk Signal Dual Arrow International Symbol No Arrow International Symbol Left Arrow International Symbol Right Arrow International Symbol Dual Arrow International Symbol Upside Down Cross With Caution Blank Signal Pole Mounting -None Selected- 4" Pole M.A. Mast Arm Flat Back Color Combinations- Plaques & Legends -None Selected- Silver Plaque/Black Legend Black Plaque/White Legend Other (Please Specify below) Special Request Items -None Selected- 2 Inch Plunger & Switch Chrome Switch & Face Nut Weatherproof Rubber Covered Switch 9/12 Inch Plaque instead of 5/7 Inch Product Three Pedestrian Button Type -None Selected- A.D.A. 2" Plunger (Americans W/Disability Act Approved) P.B.A. Original Hooded Style P.B.A. 2" Hooded Style with a 2" A.D.A. Plunger Switch Quantity Three: Legend -None Selected- Push Button Wait For Walk Signal No Arrow Push Button Wait For Walk Signal Left Arrow Push Button Wait For Walk Signal Right Arrow Push Button Wait For Walk Signal Dual Arrow International Symbol No Arrow International Symbol Left Arrow International Symbol Right Arrow International Symbol Dual Arrow International Symbol Upside Down Cross With Caution Blank Signal Pole Mounting -None Selected- 4" Pole M.A. Mast Arm Flat Back Color Combinations- Plaques & Legends -None Selected- Silver Plaque/Black Legend Black Plaque/White Legend Other (Please Specify below) Special Request Items -None Selected- 2 Inch Plunger & Switch Chrome Switch & Face Nut Weatherproof Rubber Covered Switch 9/12 Inch Plaque instead of 5/7 Inch Product Four Pedestrian Button Type -None Selected- A.D.A. 2" Plunger (Americans W/Disability Act Approved) P.B.A. Original Hooded Style P.B.A. 2" Hooded Style with a 2" A.D.A. Plunger Switch Quantity Four: Legend -None Selected- Push Button Wait For Walk Signal No Arrow Push Button Wait For Walk Signal Left Arrow Push Button Wait For Walk Signal Right Arrow Push Button Wait For Walk Signal Dual Arrow International Symbol No Arrow International Symbol Left Arrow International Symbol Right Arrow International Symbol Dual Arrow International Symbol Upside Down Cross With Caution Blank Signal Pole Mounting -None Selected- 4" Pole M.A. Mast Arm Flat Back Color Combinations- Plaques & Legends -None Selected- Silver Plaque/Black Legend Black Plaque/White Legend Other (Please Specify below) Special Request Items -None Selected- 2 Inch Plunger & Switch Chrome Switch & Face Nut Weatherproof Rubber Covered Switch 9/12 Inch Plaque instead of 5/7 Inch * Name: * E-mail: Phone Number: Address: Fax Number: City, State, Zip Code: Cell Phone: Best time to reach you: Message:   * Required

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