Please print and fill-in this form to help decide exactly what you need.

Then give us a call and we'll place your order! 708/848.9340

I. PLEASE INDICATE YOUR APPLICATION OR PROBLEM

II. FLOOR SURFACES AND CONDITIONS

A. FLOOR SURFACE

Asphalt Brick Concrete Steel Hardwood Carpet Gravel

Other

B.FLOOR SURFACE IRREGULARITIES

Metal Scraps Water Threads Fiberglass Oil

Chemicals:

Thresholds:

C. ADVERSE CONDITIONS

Excessive heat °F How long? minutes

Excessive cold °F How long? minutes

III. LOAD CAPACITY AND EQUIPMENT EVALUATION

A. Maximum load on unit: (lbs.) Number of casters per unit

B. Total weight of unit: (lbs.) Number of units

C. Total load capacity (Sum of A + B)

D. Overall size of unit: length width height

E. Will unit transport or carry people?

F. Will unit be subject to shock loading?

G. Will unit be power towed? at what speed? mph

IV. SPECIAL REQUIREMENTS

A. Caster height limitations inches

B. Top plate size length width and mounting hole spacing X

C. Wheel brake required? Y/N Swivel lock? Y/N

D. Sanitary (NSF) application? Y/N

E. Stem mounting required? Y/N

Threaded stem: Size (threads per inch) (length)

Tubular Mount: Gauge of tubing (ga.) ( inside diameter)

V. ORDER

A. Quantity

Call us on the phone and use this form to help decide exactly what you need.

)BACK(