COMPANY NAME
ADDRESS
COUNTRY
TELEPHONE		FAX
E-MAIL		CONTACT NAME

---

ITEM #1		ITEM #2
QUANTITY		QUANTITY
DUTY	Select One Heavy Light	DUTY	Select One Heavy Light
LARGEST MOTOR HP		LARGEST MOTOR HP
TOTAL MOTOR HP		TOTAL MOTOR HP
VOLTS AVAILABLE 1 PH		VOLTS AVAILABLE 1 PH
VOLTS REQ. 3 PH		VOLTS REQ. 3 PH
ENCLOSURE	Select One OD (Indoor) TEFC (Indoor / Outdoor)	ENCLOSURE	Select One OD (Indoor) TEFC (Indoor / Outdoor)

NOTES

Please describe application:

PLEASE CONTACT ME VIA:     E-MAIL     PHONE     FAX