The only People PoweredADA compliant door opener in the World !

ORDER FORMPurchase Order ______Reference ______

Direct inquiries to: EZ Door Opener LLC 77 Marion Ave, Ste.#1, Torrington, Connecticut 06790

Phone 860-618-0336 Fax 860-618-0337 email:

Visit our web site at:

The only People PoweredADA compliant door opener in the World !

Billing Information: Check if bill to ship to are the same 

Contactname and title______

Company Name______

Address 1:______

Address 2:______

City______State __Zip Code ____

Ship To:

name______

Address 1:______

Address 2: ______

City ______State __ Zip Code ____

Direct inquiries to: EZ Door Opener LLC 77 Marion Ave, Ste.#1, Torrington, Connecticut 06790

Phone 860-618-0336 Fax 860-618-0337 email:

Visit our web site at:

The only People PoweredADA compliant door opener in the World !

Phone ______Fax ______email ______

SELECT / FEATURE / ACCESSORY / QUANTITY / DESCRIPTION / EACH / DISCOUNT / EXTENSION

 / BLACK ALUMINUM / ADA-EZ Pro-version non-handed Door Mounted Battery Operator Kit*** / 2195.00

 / TRANSFORMER KIT * / BLACK
ALUMINUM / 190.00
 / CALIFORNIA KIT ** / Kit includes 4 pushbuttons 4½” x4½” / $299.95
 / Connecticut users include State Sales Tax or enter tax ID below / 6.35%
 / EXPEDITED SHIPPING / 2-3 DAY SHIPPING / $25.00
This is the total of your order including applicable taxes

FAX ORDERS to: 860-618-0337 OR CALL IN to: 860-618-0336

*TRANSFORMER KITKit includes low voltage transformer, 50 feet wiring and door cord with mountings.

**CALIFORNIA KITKit includes 4 large surface mounted pushbuttons, (4½” x4½”) with transmitters.

GROUND SHIPPING INCLUDED ON ALL ORDERS unless EXPEDITED SHIPPING SELECTED.

***Each Kit includes1 brushless DC motor/gearbox, operator push mounting bracket, door arm assembly,black anodized finish cover, 2 stainless steel wireless pushbutton transmitters, hardware pack,complete installation instructions with programming and ANSI signage. Also included, productsupport for installation and programming during normal business hours EST. Due to the design of the ADA-EZWire Free Door Opener no electrical power is required at the door location. This eliminates theneed for the customer or general contractor to supply or coordinate for an electrical drop.Should more than typical traffic need to use the door in the automatic mode (exceed 25% automatic usage) order optional plug intransformer above for an additional charge of $190.oo, shipping is free. In most states no permit is required due to low voltage design, (check with state or local authorities).

Direct inquiries to: EZ Door Opener LLC 77 Marion Ave, Ste.#1, Torrington, Connecticut 06790

Phone 860-618-0336 Fax 860-618-0337 email:

Visit our web site at:

The only People PoweredADA compliant door opener in the World !

(Fax to 860-618-0337 or regular mail, Do Not email with credit card number)

Check # _____ VISA  MASTERCARD PAYPAL DINERSCLUB AMERICANEXPRESS

CREDIT CARD #_ _ _ _-_ _ _ _-_ _ _ _-_ _ _ _ EXP _ _ / _ _ CCV _ _ _ or _ _ _ _ ZIP CODE_ _ _ _ _

Ct State Tax Permit # ______- _ _ _Federal ID # _ _ - ______(if applicable)

Nameas it appears on Card (print): ______To Days Date: ______

Authorized Signature:______Title______Print name if Different: ______

Direct inquiries to: EZ Door Opener LLC 77 Marion Ave, Ste.#1, Torrington, Connecticut 06790

Phone 860-618-0336 Fax 860-618-0337 email:

Visit our web site at: