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Products
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Custom
Contact Us
- Contact Us
- Application Forms

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Pick-Module Safety System
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Factory Supply Inc.

3412 49th Street North
Saint Petersburg, Florida 33710

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Request a Quote

Name*
First Name Last Name
Company
Email
Phone*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Where Did You Hear About Us?
- Email Campaign
- Magazine
- Search Engine i.e. Google
- Social Media
- Other
Where Did You Hear About Us?
Product Name*
Upload A File
Drop files here or
Message

QUOTATION TYPE*
CUSTOMER INFORMATION
Company Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
First Last
Email*
Phone*
Cell*
PROJECT INFORMATION
Please Indicate What Unit of Measures You Intend on Using Within This Form
- lb
- kg
- in
- cm
What are we picking up?*
What is the lifting surface like, i.e. smooth, rough, porous, etc.?*
Length
Length Minimum*
Length Maximum*
Width
Width Minimum*
Width Maximum*
Height
Height Minimum*
Height Maximum*
Weight
Weight Minimum*
Weight Maximum*
Type of Lift Required*
Operational Method*
Notes*
Maximum Swing Arm Length Requested*

Name*
First Name Last Name
Email*
Phone
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How many pits do you need covered?
Internal WIDTH at top of pit
Feet and Inches
Internal LENGTH at top of pit
Feet and Inches
Is there a catwalk across the pit?
Are there stairs into the bay?
Is there steel edge along the total length of both sides?
Do you need connection hardware?
Do you have an oil drain pan?
Upload A File
Drop files here or
Anything else we need to know?

QUOTATION TYPE*
CUSTOMER INFORMATION
Company Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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
What is the Wheel Configuration?*
Please Upload an Image of the Connection Point
Drop files here or
Will the Machine Need to Travel Up or Down any Slopes with a Load?
Where will the Machine be Used?
Do You Require a Stainless Steel Machine?
Will the Machine be Operating in an Explosive or Potentially Explosive Environment?
What Do You Want to Improve?
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?
Please Provide the Degree Angle or Dimensions of the Slope
Will the Machine Need to Travel Up or Down any Slopes Without a Load?
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?
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?
How Long can the Battery be Charged During These Periods?
Trolley Overview
Does the Trolley Exist?*
Is the Trolley Designed?*
Do you Require Advice on a Trolley Design?*
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?*
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?
If Yes, Please Provide the Dimensions of the Obstruction
L x W x H
Wheel Material
Wheel Condition
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
If Connecting to the Square or Rectangle Please Provide Dimensions
L x W x H
Is There Unrestricted Access to the Connection Point?
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