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CART MOVER APPLICATION FORM
QUOTATION TYPE
*
Budgetary (project funding)
Firm (funded project)
CUSTOMER INFORMATION
Company Name
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
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Austria
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Benin
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Bouvet Island
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British Indian Ocean Territory
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Bulgaria
Burkina Faso
Burundi
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Cameroon
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Central African Republic
Chad
Chile
China
Christmas Island
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Congo, Democratic Republic of the
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Contact Name
*
First
Last
Email
*
Phone
*
Cell
*
Cart Specifications
Please Indicate What Unit of Measures You Intend on Using Within This Form
*
lb
kg
in
cm
N
Max Load Weight
*
Is the Load to be Moved On
*
Casters
Rails
Other
What is the Wheel Configuration?
*
2x Fixed, 2x Swivel
4x Swivel
4x Swivel with Directional Lock
2x Fixed Casters, 2 Support Legs
4x Fixed
1x Swivel, 2x Fixed, 1x Swivel
2x Swivel, 2x Fixed, 2x Swivel
Other, Please Attach Photo
Please Upload an Image of the Connection Point
Drop files here or
Select files
Max. file size: 128 MB.
Will the Machine Need to Travel Up or Down any Slopes with a Load?
*
Yes
No
Where will the Machine be Used?
*
Inside
Outside
Both
Do You Require a Stainless Steel Machine?
*
Yes
No
Will the Machine be Operating in an Explosive or Potentially Explosive Environment?
*
Yes
No
What Do You Want to Improve?
*
Efficiency
Safety
Environment
Are Any of the Following Applicable for Your Environment?
*
Temperature
Explosive
Radiation
Ingress Protection
Clean Room
Stainless Steel
Other
Will the Machine Need to Travel Up or Down any Slopes With a Load?
*
Yes
No
Please Provide the Degree Angle or Dimensions of the Slope
*
Will the Machine Need to Travel Up or Down any Slopes Without a Load?
*
Yes
No
Please Provide the Degree Angle or Dimensions of the Slope
*
Will the Floor Be
*
Clean
Wet
Dusty
Greasy/Oily
Other
Will the Machine Need to Move Over Obstacles?
*
Yes
No
Which Obstacles?
*
Curbs
Speed Bumps
Raised Rails
Recessed Rail/Gaps in Floor
Other
Please Note the Size of the Obstacles
*
Please state the name of the obstacle, height/depth and width in inches.
Where Will the Machine Be Used?
*
Inside
Outside
Usage
How is the Load to be Moved?
*
Push
Pull
Steer
What is the Approximate Distance Travelled Per Move With the Load?
*
What is the Approximate Distance Travelled Per Move Without the Load?
*
How Many Days in a Week will the Machine be Used?
*
How Many Shifts are there Per 24 Hours?
*
How Many Times Per Shift will the Machine be Used?
*
How Many Times Per Hour will the Machine be Used?
*
When can the Machine be Charged?
*
2-10 Times per Shift
Overnight
How Long can the Battery be Charged During These Periods?
*
10-20 Min
21 - 60 Min
61 - 150 Min
Overnight
Trolley Overview
Does the Trolley Exist?
*
Yes
No
Is the Trolley Designed?
*
Yes
No
Do you Require Advice on a Trolley Design?
*
Yes
No
How Many Trolleys Do You Have?
*
How Many Different Trolley Types Require Moving?
*
If you have multiple trolley types we will require details for each type.
How Many Trolleys Require Moving at Once?
*
Can we Attach a Standard Female Coupling?
*
Yes
No
Trolley Details
Dimensions of the Load
*
L x W x H
Height of Load
*
Distance Between Casters Rotated In
*
Is There an Overhang, If So What Size Is It?
*
L x H
Are There any Obstructions on the Underside of the Trolley?
*
Yes
No
If Yes, Please Provide the Dimensions of the Obstruction
*
L x W x H
Wheel Material
*
Polyurethane
Nylon
Steel
Rails
Rubber (Pneumatic)
Other
Wheel Condition
*
New/Nearly New
Moderately Worn
Worn
Poor
Wheel Condition Notes
*
Notes on Load
*
What Are You Connecting To?
*
Square
Rectangle
Angle
I-Beam
U-Channel
Round
Half-Round
Other (Please Attach Photo)
File
Drop files here or
Select files
Max. file size: 128 MB.
If Connecting to the Square or Rectangle Please Provide Dimensions
*
L x W x H
Is There Unrestricted Access to the Connection Point?
*
Yes
No
Load Testing: Stain Read 1
*
Load Testing: Stain Read 2
*
Load Testing: Stain Read 3
*
Load Testing: Stain Read 4
*
Load Testing: Stain Read 5
*
Additional Information
Comments
File
Drop files here or
Select files
Max. file size: 128 MB.
Δ
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