General Inquiry Form

Customer Information

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Dealer:
Dealer Name:
Company:
Contact:
Title:
Email:
Email where RFQ copy will be sent:
Phone:	Ext.:

Fax:
Mobile:
Address:
Address Cont:
City:
State:	Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming
Zip Code:

Quotation Type

Order of Magnitude:		Budget Pricing:		Firm Pricing:

 

1. Application Type (Product Handling)

Type:
Roll:
Coil:
Barrel:
Other:
Quantity:
Number of Different Sizes:
Size:
Outside ø:
Inside ø:
Height/Length:
Maximum Weight:
Grab By:
Outside ø:
Inside ø:
Other:
Orientation:
Orientation For Pick-Up:
Deposit:
Sample:
Attachment:	Include a drawing or picture of the product(s) to be handled

Weighting:

Max/Min:
Maximum Weight:
Minimum Weight:
Resolution:
Accuracy (+/-):
Count:
Count/Weigh:	Yes No

Tote Handling:

Size:
Length:
Width:
Height:
Weight:
Access By:
Under Tote:
Lid:
Overhang/Lip of Tote:
Stacking:
Stackable?:	Yes No
Quantity High:
Sample:
Attachment:	Include a drawing or picture of the product(s) to be handled

Other:

Size:
Length:
Width:
Height:
Weight:
Comments:
Describe the product(s) to be handled:

 

2. Lift Requirements:

Lifting Height:
Minimum:
Maximum:
Finish:
Powder Coated Paint/Anodized:
Stainless Steel/Anodized:

Lifts/Shifts:
Estimated Number of Lifters Required:
Lifts per Hour:
Number of Shifts:

 

3. Transport Requirements:

Loops:
Length of Transport Loop (Feet):
Number of Stops:
Trips per Hour:

Floor/Aisle:
Floor surface Conditions:
Aisle Restrictions:
Width:
Max width of Lifter (Inches):

 

Attachment:

Attach a sketch showing clearances if form information needs expanded:

 

Notes:

Notes/Comments:

 

The LIFT-O-FLEX® can help eliminate and/or reduce Workman's Compensation Risks, increase efficiency and productivity through a safer and healthier workplace.