First Name *
             
    
    
        Last Name *
             
    
    
        Phone Number *
             
    
    
        Email Address *
             
    
    
        Location *
            
                Select a Location 
                
                    Assumption, IL 
                
                
                    Atwood, IL 
                
                
                    Bloomington, WI 
                
                
                    Carlinville, IL 
                
                
                    Casey, IL 
                
                
                    Cuba City, WI 
                
                
                    Edinburg, IL 
                
                
                    Effingham, IL 
                
                
                    Fulton, IL 
                
                
                    Hamel, IL 
                
                
                    Havana, IL 
                
                
                    Lanark, IL 
                
                
                    Litchfield, IL 
                
                
                    Mattoon, IL 
                
                
                    Monroe, WI 
                
                
                    Montfort, WI 
                
                
                    Mt. Horeb, WI 
                
                
                    Newton, IL 
                
                
                    Perry, IL 
                
                
                    Petersburg, IL 
                
                
                    Shelbyville, IL 
                
                
                    Vandalia, IL 
                
                
                    Vincennes, IN 
                
                
                    Virden, IL 
                
                
                    White Hall, IL 
                
                
                    Winchester, IL 
                
             
         
    
    
        Year *
             
    
    
    
        Make *
             
    
    
    
        Model *
             
    
    
    
        Hours
             
    
    
    
        Serial Number
             
    
    
    
        Rate the Quality/Condition of Your Machine
            
                Rate Your Machine 
                1 (Bad Condition) 
                2 
                3 
                4 
                5 
                6 
                7 
                8 
                9 
                10 (Great Condition) 
          
    
    
    
        Additional Specs/Description
            
         
    
    
    
        New Purchase