SRL Exchange Order Form

  • (mm/dd/yyyy)
  • Payment Type
    • Bill to Information

    • Ship to Information

    • Unit #1

    • Manufacturer
    • Reason for Exchange
    • Unit #2

    • Manufacturer
    • Reason for Exchange
    • Unit #3

    • Manufacturer
    • Reason for Exchange
    • SRL Exchange Price List

      Capital Safety UltraLok - $425.00

      Miller MightyLite - $315.00

      Miller Falcon - $318.00

      *Prices Does Not Include Shipping

    • By signing this order, the customer acknowledges:

      Fall Protection Systems is providing a recertified Self Retracting Lifeline (SRL) to the client in return for the same make and model of Self Retracting Lifeline from the client. Upon receipt of recertified SRL(s), the customer will box up and send the SRL(s) requiring recertification back to Fall Protection Systems with the box and label provided for this order. If the same amount, make and model of SRLs is not returned to Fall Protection Systems, we will issue an invoice to the client for the full replacement value of the missing SRLs. 

      Note: Some models are not in our stock. These models will require the customer to send in the unit(s) to be recertified directly to the manufacturer. Once recertified, the manufacturer will send the exact same unit back to the customer.  FPS will supply the required shipping label(s). 

      Customer is responsible for all freight charges. (Typically, $45.00 per unit.)

      * Some units can not be recertified.  

      **Upon, inspection/re-certification, any internal core damage to the mechanism requiring additional repairs or damage to the housing, may be an additional charge.  

    • Customer Signature