QUOTATION REQUEST FORM

COMPANY NAME  

ADDRESS                 

CITY, STATE, ZIP   

CONTACT INFORMATION 

PH:       FAX:     CELL PH: 

EMAIL: 

TYPE LIFT    PLATFORM SIZE    WEIGHT CAPACITY 

TRAVEL HEIGHT    (Floor Level to Floor Level)   FLOOR OR PIT MOUNTED 

NUMBER OF LEVELS ( Including floor level )    TYPE OF LOAD 

CONFIGURATION  ( C,Z, OR 90 DEGREES)    VOLTAGE & PHASE 

RAMP REQUIRED    LOAD HEIGHT    LOCATION 

SPECIAL REQUIREMENTS