*Contact Name:	*Email Address:
Phone:	Fax:
Shipping Info: (For freight purposes)
Company Name
Address 1:	Address 2:
City, State Zip/Postal Code:	Country:

1) What do you need your VRC do do?			2) How often will it be used?
3) Weight capacity: LBS.	4) Carriage size: (inches)		5) Loading/Unloading method:
6) Travel height: IN.	7) Power available:
8) Additional notes