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Product Request Form

Complete this form and one of our Inside Sales Account Managers will contact you shortly.

Dealer Information

Company*

Contact Name*

Address*

City*

State/Province*

Postal Code*

Country*

Telephone*

Email Address*

End User Information

Company*

Contact Name*

Address*

City*

State/Province*

Postal Code*

Country*

Telephone*

Email Address*

Equipment Requested

Machine Type:
   
Battery Stands:
 
   

Forklift Specifications

Quantity Make Model Roller Height Rollers
or Slides
Battery Removal Outriggers
A
B
C
D

Outrigger Measurements

Truck Outrigger Width (A) Truck Width (B) Outrigger to Batt Comp (C) Batt Comp Width (D) Min Height of Outrigger (E) Max Height of Outrigger (F) Top of Rollers to Floor (G)
A
B
C
D

Battery Specifications (Battery A should match with Truck A)

Quantity Stored Make Model Size Weight (lbs) Total Batteries in Fleet Batteries per Truck
A
B
C
D

Charger Specifications (Charger A should match with Battery A)

Quantity Stored Make Model Size
(L x W x H)
Weight (lbs) Mounting via** If Stackable, how high? AC Vltg* AC Amp Draw*
A
B
C
D
*Note: Required when Charger Power Modules are being purchased **Note: This field is required to determine charger layout

Battery Room Information

Drawing Layout Required?

What is the area available in feet (L x W)?

BHS Install?

What is the clear ceiling height (feet) in the battery room/area?

Are there floor drains in the battery room?

Are there any other obstructions in the room/area?

Will existing battery handling equipment be incorporated into new system?

Select the area description from drop down:

Additional Application Information