Customer Information
Date *	Order # *		Phone *
Company *			Mobile
Contact *			Fax *
Address *			Email *

Machine Specifications		Pickup Measurements (refer to drawing below)		Crowd (refer to drawing below)
Make *		A - Pin Diameter	mm	More
Model *		B - Inside Boss	mm	Standard
Capacity *	tonne	C - Pin Centres	mm	Less

Product Order
Product Description	Item Price (ex GST)	Qty	Width (refer to drawing)		G.E.T.		Pin Requirements
			Nominal D (mm)	Dig E (mm)	Bolt On Edge	Side Cutters	Welded In	Removeable		Pins Qty 0, 1 or 2
								Bolt & Nut	Circlip
					YesNo	YesNo	YesNo	YesNo	YesNo
					YesNo	YesNo	YesNo	YesNo	YesNo
					YesNo	YesNo	YesNo	YesNo	YesNo
					YesNo	YesNo	YesNo	YesNo	YesNo
					YesNo	YesNo	YesNo	YesNo	YesNo

Serial Number / s
Paint Colour

Authorised By Customer	Name *	Date *
	Email *	Ver Code *
please enter the verification code (case sensitive) fields marked with * are mandatory

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