A & G Manufacturing

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General Information

Customer Information

Business Name

Contact Person

Telephone#       Fax#

E-mail Address      Website

Street 1

Street 2

City      State      Zip Code

________________________________________________________________________________

Distributor Information

Business Name

Salesperson

Telephone#       Fax#

E-mail Address      Website

Street 1

Street 2

City      State      Zip Code

________________________________________________________________________________

INSTRUCTIONS: Check all items that apply and enter applicable data.

Equipment Usage

General Transport:  Unit Load     Trains              Capacity/Trailer:    

Required Number of Trailers/Train:      

Interface:  During Loading   During Off Loading?    Other:      

Type of Interface:  Lift Truck      Gravity Roller    Power Roller     Other:      

Manipulation/Position:  Rotate    Hand Maneuver   Captivate Trailer  Other:      

Operating Environment

Running Surface Material:  Concrete    Asphalt    Block (Wood, Composite)    Steel      Gravel/Stone Other:   

Sealed or Finished?  Yes       No     If Yes, type of material used:  Epoxy    Clear Sealer    Paint Other:

Running Surface Condition:  Bumpy     Pock Marked    Rough Textured                               Medium Textured    Smooth   Other:     

Foreign Material/Debris:  Chips  Fasteners    Coolant    Water   Oil               Other:      

Adverse Temperatures?  Yes      No     If Yes, please describe:   

Tugging Device

Existing:      Manufacturer:               Model:    

Proposed:   Manufacturer:               Model:
                   Pull Speed:
     M.P.H.         Draw Bar Pull (if available):   

Hitch/Coupler Device

Existing:         Type:                Manufacturer:    

                      Hitch Height:  

Requested:    Hitch Type:          Hitch Height:    

Trailer Operations Information

 Locked Trains         Individual Drop/Pick-up

Spur:  Individual            Train

Couple/Uncouple from Tugging Device? Yes        No

Trailer Maneuvering Information

Aisle Width (Most Restricting):

Width of Aisles Intersecting at 90 (Worst Case):     to

180 Turns Required?  Yes    No      If Yes, total area available for turn:

Special Finish and/or Stenciling

Color:   Standard Safety Yellow     Other:    

Painting Process: Standard Powder Coat   

 Special Paint Requirement:     

Trailer Load Configuration

Dimensions of Load (s):  Width:    Length:   Height:                                               Single Level     Multiple Level

Is load equally distributed?  Yes  No     If No, give details: