Contact Information		Describe Application
Company:
Contact:*
Email*
Address:
City:
State:
Zip Code:
Country:
		Will the winch be:           Pulling                 Lifting
Phone:		Dollar Value of Load (approx.):
Fax:		Qty Needed:		Date Needed:

Line Lift Requirements - Vertical Lift Only
Line Lift:	lbs.
Special Considerations:

Line Pull Requirements - Horizontal Pull Only

Line Pull:    lbs.

Gross Weight of Load:    lbs.

Load Moves Both Directions?   Yes   No

Slope:

Yes   No

Rise:

Run:

Or Degrees:

Or Percent:

%

Wheels:

Yes   No

Lubrication:

Track:

Yes   No

Curvature (deg, chordal line, other):

Special Considerations:

Line Speed Requirement
Line Speed Requirements:		fpm
Variable Speed:		Yes   No	Variations Acceptable:
Special Considerations:

Distance of Travel
Length:	ft.	Single Layer        Full Drum
Special Considerations:

Power Requirements
Electrical:	AC        DC		Voltage:		Phase:				Cycle:
Hydraulic:	Pressure:		Flow:			Line Size:		in. dia.
Pneumatic (Air):	Pressure:		Flow:			Line Size:		in. dia.

Installation Requirements
Installation:	Base        Wall          Ceiling	Clearance Requirements:

Environment
Location:	Indoor       Outdoor       Marine       Corrosive       Hazardous
Special Considerations: (dust, chems, explosives, etc.)

Accessory Options
Brake		Limit Switch	Clutch	Pressure Bar
Slack Line Detect		Controls	Torque Limiter	Manual Override
Other:

Modifications

Groved Drum          Multiple Drum           Modified Drum Size          Level Wind          Special Finish

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