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Customer:
Address:
* Phone Number:
Fax Number:
* Contact Name:
* E-mail Address:
Customer Ref: Our Ref:
Description of Application: Click here for a full description		A. Falling Mass B. Load against a solid stop C. Load against a solid stop with shock absorbers D. Load against load with one shock absorber E. Load against load with shock absorber F. Load on incline
Environmental Conditions:
Ambient Air:		Normal Dry Humid
Ambient Temperature:		from °C to °C
Atmospheric Contaminants::		Oil Dust Salt Water Other Other: Please specify:
Application Details:
Max. Permitted Impact Force: Crane: Trolley: Other:
Stroke of Buffer Required: Deceleration rate
Impact Speed (m/s): Crane: Trolley: Other:
Total Impact Mass: Crane: Trolley: Other:
Drive Force During Impact:(NB Drive Force = Wind and/or Motor)
Crane: Trolley: Other:
Number of Buffers: Crane: Trolley: Other:
Stroke/h:
Height of Mast (Stackers):
Remarks/Special Requirements:
Mounting Details:
Painting Details:
Does the application have any angular issues. If so, what?
Please supply a sketch if possible
Number of Buffers required:
Questionnaire completed By:		Date: