Name of the Company:
Postal Address:
Name of Contact Person:
Mobile No:
Designation:
Land Line No:
Mail ID :
Type of Application:
Only IndoorsOnly Out Doorsboth Indoor & Outdoor Duty
No of Hours of Usage Per Shift:
No of Shifts Per Day:
Max Weight of Load Being Handled at Ground Level:
Slopes / Gradients / Ramps to be climbed
1 in 121 in 101 in 81 in 61 in 51 in 4N/A
Flooring Conditions:
Cement FlooringUn-Even FlooringDouble-DeepPolyurethane Flooring
Battery Charging Area:
AvailableNot Available
Any Hazardous / Inflammable / Explosive Materials to be Handled :
YesNo
Input this code:
Δ
