ALX Inquiry Form - Waterflood Service & Sales LTD.

Customer Information

Customer:

Attention:

Address:

City:

Province/State:

ZIP/Postal Code:



Phone:

Fax:

Cell:

E-mail:

Sales Contact:

Site Location:

Site LSD:

Driver Requirements

Area Classification:
Driver Type:
Prefered Manufacturer:

ALX Supplied



 
Driver Sheave:

Bushing:

Belts:






 
Build Options

Model:    Qty:  
CB Effect:    Weights:  
Paint: ALX Customer:    
Prime Drive: ALX Std. (High Mount) Low Mount
Extended Brake Cable      Brake Mount      Engine Rails      Slotted Back  
Belt Guard: Partial      Full Mesh      Fully Enclosed      Fiber Glass
Other:    
Vibration Switch: VS2EX VS2  
Precast Base: Sleeper:       Main:    
CW Fence: ALX Std. Other:    
Oil Fill: ALX Std. Other:    
Gear Box Sheave: ALX Std. Other:    
Tie Downs: ALX Std. Other:    

Delivery Options

Delivery Date Requested: YY/MM/DD Trucking:  WSS   Other  
Loading:   WSS   Other  


Finance Options

Purchase    Lease to Purchase    Rent


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Other Options or Comments