Customer
Title
Company
Address
City
State
Zip
Phone:
Fax
Email
Describe what you want to do?
Size
Length
Width
Describe load to be moved
Approximate location of center of gravity
Movement desired
Distance:
Frequency
Describe Pathway movement
How will load be placed on Air Caster Equipment
Manual or Power movement?	Manual Powered
Interested in Drive Tractor?	Yes No
Allowable size or space available for Air Caster Equipment
Air Supply	Very Adequate Marginal
Compressor Size
Describe Floor	Very Smooth Smooth Some Roughness
Can cracks or joints be sealed?	Yes No
Recommendations needed on floor repair?	Yes No
How soon will Air Caster equipment be needed?
How soon will Air Caster equipment be Funded?
Type of response needed	Firm Quotation Budgetary Other
Person to receive quotation
Address, if different