Customer: Address (including City, State & Zip): Requested by: Phone: Fax: E-mail: Product: Length: Min. Max. Width: Min. Max. Height: Min. Max Weight: Min. Avg. Max.
Infeed Height: Outfeed Height: Elevation Change:
Direction: Up Down
Type/Model: Select one . . . Type A-1: Elevate Clockwise Type A-2: Descend Clockwise Type A-3: Elevate Counter-Clockwise Type A-4: Descend Counter-Clockwise Type B-1: Elevate Clockwise Type B-2: Descend Clockwise Type B-3: Elevate Counter-Clockwise Type B-4: Descend Counter-Clockwise Type C-1: Elevate Clockwise Type C-2: Descend Clockwise Type C-3: Elevate Counter-Clockwise Type C-4: Descend Counter-Clockwise Type D-1: Elevate Clockwise Type D-2: Descend Clockwise Type D-3: Elevate Counter-Clockwise Type D-4: Descend Counter-Clockwise Other ...
Products/Minute: Conveyor Speed: Power Supply: Finish:
Special Requests:
PLEASE CALL OR FAX US IF YOU HAVE NOT HEARD FROM US IN 24 TO 48 HOURS AFTER SENDING THIS FORM.