| *First Name: |
|
|
| *Last Name: |
|
|
| Title: |
|
|
| Organization: |
|
|
| Street Address: |
|
|
| Address (cont.): |
|
|
| City: |
|
|
| State/Province: |
|
|
| Zip/Postal Code: |
|
|
| Country: |
|
|
| Work Phone: |
|
|
| Home Phone: |
|
|
| FAX: |
|
|
| *E-mail: |
|
|
| |
|
|
| Please select one: |
|
|
| Brand Name of Bin: |
|
|
| How many bins: |
|
|
| Model No: |
|
|
| *Diameter: |
|
|
| *Eave Height ( side wall ): |
|
|
| *Peak Height ( over all ): |
|
|
| Type of roof: |
|
|
| Type of bottom: |
|
Flat Hopper
Raised floor
|
| If raised floor what is the
height: |
|
|
Where are grain temperatures
to
be read from: |
|
Portable down the side
Office |
| Are you going to install?: |
|
Yes No |
| If no, where is the location: |
|
|
| Is there an outside ladder on the
bin: |
|
Yes No |
| Is a portable instrument
needed: |
|
Yes No Unsure |
| Any comments or
concerns: |
|
|
