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
Customer Information
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Distributor Information
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INSTRUCTIONS: Check all items that apply and enter applicable data.
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:
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:
Existing: Manufacturer: Model:
Proposed: Manufacturer: Model: Pull Speed: M.P.H. Draw Bar Pull (if available):
Existing: Type: Manufacturer:
Hitch Height:
Requested: Hitch Type: Hitch Height:
Locked Trains Individual Drop/Pick-up
Spur: Individual Train
Couple/Uncouple from Tugging Device? Yes No
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:
Color: Standard Safety Yellow Other:
Painting Process: Standard Powder Coat
Special Paint Requirement:
Dimensions of Load (s): Width: Length: Height: Single Level Multiple Level
Is load equally distributed? Yes No If No, give details:
