Customer Information

                                                  Name of Company:

                                                          Contact Name:

                                                                        Phone:

Ship To Address   Address:  City:  State: Zip

Billing To Address   Address:  City:  State: Zip

Application Information

What product or service does your company provide? Warehousing Heavy Mfg. Light Mfg. Agricultural Paper Products Printing/Publishing Textile Plastic Food Lumber/Wood Stone/Clay/Glass Primary/Metals Stevedoring Chemical Foundry Rubber Freezer Other

Do you currently use forklift equipment? Yes No

What is your fuel preference? LPG Diesel Gas Electric

What material or product will you be handling with the forklift?

What is the average load weight will you need to handle?

What is the maximum load weight that you need to handle?

Is the product stored on a pallet? Yes No

If so, what are the dimensions of the pallet?

Will the load be stored in the storage rack? Yes No

Will you need to load/unload trailers & boxcars with the forklift? Yes No

Will the forklift be used... Indoors  Outdoors  Both

Are all surfaces paved? Yes  No

Will the forklifts be used on any ramps?  Yes  No

What is the lowest overhead obstruction that the forklift will need to pass under?
(Examples - doorway, overhead, trailer/boxcar entry, cable or pipe chase, 
 heaters, sprinkler systems)

How many hours will the forklift be used per week?

How you you intend to acquire this forklift? Purchase Lease to own Lease to expense Rent

Any other information that you think we might find useful in searching for you lift truck: