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General Contact Form
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Application Inquiry Form
Coordinator *
--Select a Coordinator--
Kathy Bell
Jim Trombley
Paul Brumleve
Rick DaSilva
Steve Lamoureux
Other
Date *
Salesperson *
Distributor *
End User *
Type of Industry *
City *
State/Province *
Zip/Postal Code
Country
Application:
How is lift used? *
Product Being Handled *
Width *
Length *
Height
Weight *
Platform Size *
Travel Time Up *
Travel Time Down *
Lowered Height *
Vertical Travel *
Raised Height *
How is Lift Loaded? *
Over
End
Side
Raised
Lowered
How is Off Loaded? *
Over
End
Side
Raised
Lowered
Is lift loaded evenly? *
Yes
No
If neither, how is lift loaded?
Jobs per cycle *
Cycles per hour *
Hours per day *
Days per week *
Annual *
Floor Mount
Pit Mount
Tapeswitch
Bevel Toe Guard (requires oversize platform)
Bellows Skirting (requires oversize platform)
Portable
If portable, how?
Other
Deck, Tread and Handrails:
(Check all that apply.)
Smooth Deck
Diamond Tread
Handrails
If handrails, where?
Turntable:
If turntable, what size?
Tilt Top:
Tilt Top Degrees
--Select a Degree--
30
45
90
Other
If other, please specify
Power:
Type of Power Unit *
--Select a Type--
Internal
External
None
Primary Voltage *
--Select a Voltage--
115/1/60
230-460/3/60
Controls *
--Select a Type--
Push Button
Foot Switch
None
Starter *
--Select a Type--
Motor Starter/Transformer (for 3 phase)
None
Line Switch *
--Select a Type--
Up
Down
Nema Classification *
Pricing:
Specify
Sales Information:
Inquiry Quantity *
Inquiry Type *
--Select a Type--
Budget
Current Consideration
Immediate Purchase
If for immediate purchase, please specify expected order date
Delivery Requirement *
Competition - Who?
Other Sales Information
* Indicates a required field
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Application Inquiry Form
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