Distributor Molder Spec Form
Please fill out the following completely and carefully. Errors on this form can result in additional charges. If you have any questions please give us a call at 800-258-1380.
Your Company Name
*
Your Name (Sales Representative)
*
First Name
Last Name
Your Contact Email
example@example.com
Your Contact Phone Number
*
Choose Your Molder
Please select your molder and power requirements from the list below.
POWER REQUIREMENTS - Due to a manufacturing change in motors, please select the molder and power requirements for your customer below.
*
154CE Single Phase 208V
154CE Single Phase 240V
206 Single Phase 208V
206 Single Phase 240V
206 THREE Phase
209 115V 20 AMP CIRCUIT REQUIRED
Freight Information
To ensure proper delivery, please complete the following
DELIVERY ADDRESS TYPE
*
COMMERCIAL
RESIDENTIAL - Additional Accessorial Fees Apply
COMMERCIAL is only for INDUSTRIAL areas. All others are RESIDENTIAL.
Should an appointment be made for delivery?
*
Yes - Additional Fees Apply
No
Additional Fees May Apply.
Please list the business hours when the delivery can be accepted.
*
Ex. 7am - 2pm
Does the delivery address have a Loading Dock?
*
Yes
No
Does the delivery address require a Lift Gate?
*
Yes - Additional Fees Apply
No
Additional Fees May Apply.
If "YES" please provide contact phone number for Delivery Address
Please list any additional details about the delivery address that may restrict access for the trucking company.
Example: Locked gates, Security check point, etc.
Submit Molder Spec Form
Should be Empty: