Grapeland Supply Hose Sale Order Form
Please fill out your details and specify order/repair preferences, and we'll reply shortly to confirm a quote. Questions? Call 509-522-1141 or email sales@grapelandsupply.com and we're happy to help!
Customer Name
*
First Name
Last Name
Company
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
New or Repair?
*
Repair
New Hose
Consultation Needed
Type of hose
*
Please Select
K-Line
Spiralite
Garden Hose
Other
Hose diameter (inches)
*
Hose length (feet)
*
Tri-clamp end size (inches)
Re-use existing barbs/fittings if possible?
Yes
Include hose bumpers? (doughnuts)
Yes
Quantity
*
Description of Damage/Repair Needed
Drop-off date
*
-
Month
-
Day
Year
Date
Finish date requested
*
-
Year
-
Month
Day
Date
Additional Notes or Special Instructions
Submit Order
Should be Empty: