Company*:

 

Referred By:

 

Select ... Customer Google Magazine Postcard ThomasNet Yahoo Other

Name*:

 

if Customer” or “Other”:

 

Address*:

 

Time to Purchase:

 

Select ... 1 to 14 Days 15 to 30 Days 31 to 60 Days 61 to 90 Days After 90 Days

City*:

 

Budgetary Only:

 

Yes  No

State & Zip*:

 

   (i.e. FL & 32904)

Send Method*:

 

E-Mail Fax Mail FedEx

Phone*:

 

 (i.e. 321-733-3387)

Fax:

 

 (i.e. 321-733-9433)

E-mail:

 

 (i.e. you@yourcompany.com)

Website:

 

 (i.e. www.yourcompany.com)

Model:

 

RP-2001 RP-2010 RP-3003 
None

Quantity:

 

1 2 3 4 5+

Working Height:

 

Select ... 25 ft 50 ft 60 ft 70 ft 80 ft 90 ft 100 ft 110 ft 120 ft 130 ft 140 ft 150 ft 160 ft 170 ft 180 ft 190 ft 200 ft 210 ft 220 ft 230 ft 240 ft 250 ft 260 ft 270 ft 280 ft 290 ft 300 ft 300+ ft Other --->    if Other:

Brackets:

 

Select ... B11431 (Pivot) B11571 (Non-Pivot) 262061 (Non-Pivot) Not Sure

Tie-in Structure:

 

Notes:

 

Model:

 

Pat-850 Pat-1000 Pat-2000  None

Quantity:

 

1 2 3 4 5+

Working Height:

 

Select ... 20 ft 30 ft 40 ft 50 ft 60 ft 70 ft 80 ft 90 ft 100 ft 110 ft 120 ft 130 ft 140 ft 150 ft 160 ft 170 ft 180 ft 190 ft 200 ft 210 ft 220 ft 230 ft 240 ft 250 ft 260 ft 270 ft 280 ft 290 ft 300 ft 300+ ft Other --->    if Other:

Power:

 

Select ... 230 Volt 3-Phase 220 Volt 1-Phase 110 Volt 1-Phase

Mount Option:

 

Select ... Monorail I-Beam Other --->    if Other:

Notes:

 

Options: