| Please fill out as much information as you
can on the form below. |
| Bold fields are
required |
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Contact
Name: |
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Title: |
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Company Name: |
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Address: |
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Address (cont): |
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City: |
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County: |
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State /
Province: |
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Country: |
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Zip / Postal
Code: |
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Phone: |
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Phone 2: |
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Fax: |
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Email: |
Wheel
Requirements: |
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Wheel Diameter: |
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Tread Width: |
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Wheel Material: |
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Not Sure of Material: |
(if you don't know what material you need
check here) |
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Explain your floor conditions in
detail: |
Caster
Requirements: |
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Caster Type |
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Fastener Type: |
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Fastener size required: |
(include special height if
needed) |
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Load Capacity: |
(total) |
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Load Capacity each Caster: |
(load each caster need to
carry) |
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Brake Options: |
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More Information: |
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Shock Absorbing: |
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Stainless Steel: |
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Dual Wheel: |
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High-Temp: |
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Swivel Lock: |
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Non-Corrosive: |
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Fully sealed for clean rooms: |
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NSF Approved: |
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Other: |
Please use the comment box
below to add any additional information you feel will help us
to determine the best caster for your
application. |
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Comments: |
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