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    Product Request Form

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

    Dealer Information

    End User Information

    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