Alum-a-lift, Inc.

APPLICATION QUESTIONNAIRE

The keys to ALUM-A-LIFT are: The perception of an ergonomic lifting problem to which ALUM-A-LIFT offers a viable solution; and the importance attached to the solution by a decision-maker. ALUM-A-LIFT is configured to the application.

For our prompt response, please fill out the form below and submit it.

Your Information

Your Name:

Your Company Name:

Phone Number:

E-Mail Address:

Load Information

What is it?
Describe item, i.e. carton, cart, cage, pump, etc.

Weight of load:
Use actual weight, not safety factor.

	Pounds
	Kilograms

Maximum Height to Reach:

Minimum Height to Reach:

Constraints

Doorway
Low Ceilings
Aisle Width
Elevator
Other - Describe:

Conditions

Smooth Floor
Rough Floor
Carpeting
ESD Required
Class 100 Clean Room
Other - Describe:

Lifting Strategy & End Effecter Requirements

Generally, end effecters are designed to emulate human physical activities. Examples include: Lift, Lower, Reach, Grasp, Move, Rotate, Position, Align, Assemble and Hold.

Please check the nearest to your application.

	Basic: Tine, fork set, boom, platform, trough, sling-
	Simple: Roller deck, ball transfer, adjustable forks
	Complex: Clamp, rotate, articulate, expanding mandrel; combined (e.g. clamp and rotate, such as dump); manual or powered operation.-
	Other, Describe
Other Notes and/or Details
Any other notes, details or specifications we need to be aware of: