Custom Design Submission Form

Company Name:	Contact Name:
Address:	Phone # :	Ext:
	Mobile:
	Email:
	Website:
1) Make, model and specific cell location or name of the robot application.

2) Make, model and specific cell location or name of the robot application.

3) Approximate length of cable and hoses . What Axis are we dressing to and from:

4) Short video of motion (this is not totally necessary, but very helpful in the designing process).

5) Digital Pictures at multiple angles of the robot. Please include cable / hose termination area pictures

6) Date required of dress out and number of robots for project / location?

7) Do you require installation?

8) Do you wish to purchase mounting hardware/ brackets?

Notes

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