A & G Manufacturing
	A & G Mercury A Division of A&G Mfg. 165 Gelsanliter Rd. P.O. Box 935 Galion, Ohio 44833 Phone: 419-468-7433 FAX: 419-468-3990		General Information Customer Information Business Name Contact Person Telephone#       Fax# E-mail Address      Website Street 1 Street 2 City      State      Zip Code ________________________________________________________________________________ Distributor Information Business Name Salesperson Telephone#       Fax# E-mail Address      Website Street 1 Street 2 City      State      Zip Code ________________________________________________________________________________ INSTRUCTIONS: Check all items that apply and enter applicable data. Equipment Usage General Transport:  Unit Load     Trains              Capacity/Trailer:     Required Number of Trailers/Train:       Interface:  During Loading   During Off Loading?    Other:       Type of Interface:  Lift Truck      Gravity Roller    Power Roller     Other:       Manipulation/Position:  Rotate    Hand Maneuver   Captivate Trailer  Other:       Operating Environment Running Surface Material:  Concrete    Asphalt    Block (Wood, Composite)    Steel      Gravel/Stone Other:    Sealed or Finished?  Yes       No     If Yes, type of material used:  Epoxy    Clear Sealer    Paint Other: Running Surface Condition:  Bumpy     Pock Marked    Rough Textured                               Medium Textured    Smooth   Other:      Foreign Material/Debris:  Chips  Fasteners    Coolant    Water   Oil               Other:       Adverse Temperatures?  Yes      No     If Yes, please describe:    Tugging Device Existing:      Manufacturer:               Model:     Proposed:   Manufacturer:               Model:                    Pull Speed:      M.P.H.         Draw Bar Pull (if available):    Hitch/Coupler Device Existing:         Type:                Manufacturer:                           Hitch Height:   Requested:    Hitch Type:          Hitch Height:     Trailer Operations Information  Locked Trains         Individual Drop/Pick-up Spur:  Individual            Train Couple/Uncouple from Tugging Device? Yes        No Trailer Maneuvering Information Aisle Width (Most Restricting): Width of Aisles Intersecting at 90° (Worst Case):     to 180° Turns Required?  Yes    No      If Yes, total area available for turn: Special Finish and/or Stenciling Color:   Standard Safety Yellow     Other:     Painting Process: Standard Powder Coat     Special Paint Requirement:      Trailer Load Configuration Dimensions of Load (s):  Width:    Length:   Height:                                               Single Level     Multiple Level Is load equally distributed?  Yes  No     If No, give details:
	Copyright 2005 REN

BusinessName:              test
ContactPerson:             dean shifley
TelephoneCustomer:         
FaxCustomer:               
emailcustomer:             
websitecustomer:           
streetcustomer:            
street2customer:           
citycustomer:              
statecustomer:             
zipcodecustomer:           
DistributorName:           
DistributorSalesperson:    
DistributorPhone:          
DistributorFax:            
DistributorEmail:          
DistributorWebsite:        
DistributorStreet1:        
DistributorStreet2:        
DistributorCity:           
DistributorState:          
DistributorZipCode:        
UniteLoadYes:              
TrainsYes:                 
CapacityTrailer:           
NumberTrialersTrains:      
DuringLoading:             
DuringOffLoading:          
C5:                        
InterfaceOther:            
LiftTruck:                 
GravityRoller:             
PowerRoller:               
C9:                        
InterfaceTypeOther:        
Rotate:                    
HandManeuver:              
CaptivateTrailer:          
C13:                       
ManipulationPositionOther: 
Concrete:                  
Asphalt:                   
Block:                     
Steel:                     
GravelStone:               
SurfaceOtherYes:           
SurfaceOther:              
SealYes:                   
SealNo:                    
Epoxy:                     
ClearSealer:               
Paint:                     
SealedOther:               
Bumpy:                     
PockMarked:                
RoughTextured:             
MediumTextured:            
Smooth:                    
SurfaceComment:            
Chips:                     
Fasteners:                 
Coolant:                   
Water:                     
Oil:                       
MaterialOther:             
MaterialComment:           
TempYes:                   
TempNo:                    
TempComment:               
ExistingManufact:          
ExistingModel:             
ProposedManufact:          
ProposedModel:             
ProposedPullSpeed:         
ProposedDrawBar:           
ExistingHitchType:         
ExtisingManufact:          
ExistingHitchHeight:       
RequestedHithc:            
RequestedHitchHeight:      
LockedTrains:              
IndividualDropPickUp:      
IndividualSpur:            
TrainSpur:                 
CoupleUnCoupleYes:         
CoupleUnCoupleNo:          
TrailerIsleWidth:          
WidthIsleFrom:             
WidthIsleTo:               
DegreeYes:                 
DegreeNO:                  
AvailableTurningRoom:      
ColorStandard:             
ColorOther:                
OtherColor:                
StandardPowderCoat:        
SpecialPainting:           
SpecialPaintComment:       
DimensionsWidth:           
DimensionsLength:          
DimensionsHeight:          
SingleLevel:               
MultipleLevel:             
LoadEqualYes:              
LoadEqualNo:               
NoDetails:                 
B1:                        Submit
Remote Name:               70.104.96.118
Remote User:               
HTTP User Agent:           Mozilla/4.0 (compatible; MSIE 7.0; Windows NT 5.1; .NET CLR 1.1.4322; .NET CLR 2.0.50727)
Date:                      10/30/2007
Time:                      07:28:10 AM

BusinessName:              test
ContactPerson:             dean  l shifley
TelephoneCustomer:         
FaxCustomer:               
emailcustomer:             
websitecustomer:           
streetcustomer:            
street2customer:           
citycustomer:              
statecustomer:             
zipcodecustomer:           
DistributorName:           
DistributorSalesperson:    
DistributorPhone:          
DistributorFax:            
DistributorEmail:          
DistributorWebsite:        
DistributorStreet1:        
DistributorStreet2:        
DistributorCity:           
DistributorState:          
DistributorZipCode:        
UniteLoadYes:              
TrainsYes:                 
CapacityTrailer:           
NumberTrialersTrains:      
DuringLoading:             
DuringOffLoading:          
C5:                        
InterfaceOther:            
LiftTruck:                 
GravityRoller:             
PowerRoller:               
C9:                        
InterfaceTypeOther:        
Rotate:                    
HandManeuver:              
CaptivateTrailer:          
C13:                       
ManipulationPositionOther: 
Concrete:                  
Asphalt:                   
Block:                     
Steel:                     
GravelStone:               
SurfaceOtherYes:           
SurfaceOther:              
SealYes:                   
SealNo:                    
Epoxy:                     
ClearSealer:               
Paint:                     
SealedOther:               
Bumpy:                     
PockMarked:                
RoughTextured:             
MediumTextured:            
Smooth:                    
SurfaceComment:            
Chips:                     
Fasteners:                 
Coolant:                   
Water:                     
Oil:                       
MaterialOther:             
MaterialComment:           
TempYes:                   
TempNo:                    
TempComment:               
ExistingManufact:          
ExistingModel:             
ProposedManufact:          
ProposedModel:             
ProposedPullSpeed:         
ProposedDrawBar:           
ExistingHitchType:         
ExtisingManufact:          
ExistingHitchHeight:       
RequestedHithc:            
RequestedHitchHeight:      
LockedTrains:              
IndividualDropPickUp:      
IndividualSpur:            
TrainSpur:                 
CoupleUnCoupleYes:         
CoupleUnCoupleNo:          
TrailerIsleWidth:          
WidthIsleFrom:             
WidthIsleTo:               
DegreeYes:                 
DegreeNO:                  
AvailableTurningRoom:      
ColorStandard:             
ColorOther:                
OtherColor:                
StandardPowderCoat:        
SpecialPainting:           
SpecialPaintComment:       
DimensionsWidth:           
DimensionsLength:          
DimensionsHeight:          
SingleLevel:               
MultipleLevel:             
LoadEqualYes:              
LoadEqualNo:               
NoDetails:                 
B1:                        Submit
Remote Name:               70.104.96.118
Remote User:               
HTTP User Agent:           Mozilla/4.0 (compatible; MSIE 7.0; Windows NT 5.1; .NET CLR 1.1.4322; .NET CLR 2.0.50727)
Date:                      10/30/2007
Time:                      07:28:27 AM