Lift-O-Squeeze 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:

Notes/Comments

Notes:

 

1. Drum Handling:

Size:
Outside ø-Top:	(Min)   (Max)
Outside ø-Top:	(Min)   (Max)
Taper (Bottom ø):	(Min)   (Max)
Taper (Bottom ø):	(Min)   (Max)
Height:	(Min)   (Max)
Height:	(Min)   (Max)
Weight:	(Min)   (Max)

2. Drums:

Drum Type:	Fiber Steel Stainless Steel Plastic Ribbed
Drum Pickup:	Floor  Pallet Other:

3. Roll Handling:

Size:
Outside ø:	(Min)   (Max)
Width:	(Min)   (Max)
Width:	(Min)   (Max)

4. Roll Handling:

Width:	(Min)   (Max)
Depth:	(Min)   (Max)
Height:	(Min)   (Max)
Weight:	(Min)   (Max)

5. Other:

Describe:

6. Load Pickup:

Floor:
Pallet:
Other:

7. Leg:

Clearance Height:
Inside Clearance:

8. Quantity:

Estimated quantity of lifters required?
Painted:
Stainless Steel/Anodized:

9. Per Day Numbers:

Number of shifts/day?
Load Movements/day?

10. Floor Surface:

What is the floor surface & environment lifter is to operate in?
EEx d Requirement:
Aisle Restrictions?
Clearance for outriggers?

 

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CREATING THE BALANCE
" Through the application of ergonomic principles to your workplace, we can help you create a balance between human capabilities and task demands. This balance will provide a safe and healthy environment for your employees".