Custom Application Design Assistance Request

Contact name

Title

Company
Type of business Distributor Manufacturer Retailer Other

Street address

City

State/Province

Zip/Postal code

Phone

Fax

e-mail

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Application Information

Application use
This product will be used to...

Capacity
lbs.

Pit installed yes no
Label

Lift speed
LabelWith load Without load

Cycles
LabelPer hour Per day Internittant

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Platform size
W x L

Lowered height (A) Total travel (B) Raised height (C)

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Deck design

Flush frame & deck

Toe clearance

Tapered toe guard

Controls

Remote push-button

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Power Pack

Remote

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Safety Features Electric trip bars Manual indicator bars Other

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Other requests