Machine Information:

Machine Type: {Select Machine Type:1}

Make: {Make:3}

Model: {Model:5}

Serial #: {Serial:6}

Part / Application Information:

Maximum Gripping Range: {Maximum Gripping Range :14}

Minimum Gripping Range: {Minimum Gripping Range :15}

Lubrication: {Lubrication :36}

Part Weight: {Part Weight :28}

Part Diameter: {Part Diameter :16}

Swing Away Lever: {Swing Away Lever :37}

Steady Rest Operation: {Steady Rest Operation :38}

Bracket Information:

Does Machine Have Existing Bracket: {Does Machine Have Existing Bracket :39}

Bracket Make / Model: {Bracket Make / Model :41}

Bolt Pattern: {Bolt Pattern :42}

Type of Bracket: {Type of Bracket :43}

{Attached Part:17}

Contact Information:

Company Name: {Company Name:21}

Address: {Address:20}

Contact Name: {Contact Name:22}

Phone Number (mobile): {Phone Number (mobile):25}