CUSTOMER INFORMATION

Customer Name:

Region:

North America Central America South America Europe Africa Middle East China Asia Pacific Australia

Order Date:

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Ship Date:

dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / mm 1 2 3 4 5 6 7 8 9 10 11 12 / yy 08 09 10 11 12 13 14 15

Purchase Order #:

Service Order/ Contract #:

UNIT INFORMATION

Escalator Model:

Handrail Part #:

Balustrade:

Solid Balustrade Glass Balustrade

# of Handrails

@ Length

* Custom colours available upon request

@

*Colour:

-- Standard Black Red Beige Brown Grey Blue Green Charcoal

Configuration:

Endless EHC Field Splice Customer Field Splice End Preparation

Location:

Indoor Outdoor

Motion Indicators:

None Dots Diamonds Dots & Diamonds

Spacing:

OTHER PRODUCTS

Handrail Cleaner: -- Trial Size 12 Oz. 1 Gallon

Quantity:

Handrail  Polish:  -- Trial Size 12 Oz. 1 Gallon

Quantity:

RapidRail Installation Tool

Quantity:

CONTACT INFORMATION

Invoice Address:

Ship Here
Ship To Address:

Ship Here
Ship VIA:

SOS Ground Air Ocean

Requester's Name:

Title:

Email Address:

Telephone #:

Fax #:

Notes:

Box Markings:

Please confirm my order by: Phone Fax Email

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