Vertical Lifting Equipment Quote Request Form

Name:
Title:
Company Name:
Division:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Country:
Phone:
Fax:
Email:
May we send you periodic email with information about our products?	Yes   No
Company Web Site:
How did you learn about our website?		Literature
		Business Card
		Web Search Engine. Please specify:
		Magazine. Please specify:
		Linked From Web Site. Please specify:
		Other. Please specify:
Coil Data Maximum weight pounds Maximum width inches Minimum width inches Maximum ID inches Minimum ID inches Maximum OD inches Minimum OD inches
Coil surface	Dry Yes No Oily Yes No Banded Yes No
Duty cycle	Lifts per day

Hoist Hook Data
Dim. D	inches
Dim. E	inches
Dim. F	inches
Dim. G	inches
Dim. H	inches
Dim. K	inches
Dim. L	inches
Hook capacity	tons
Manufacturer

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