Simplified Roll Order/Quotation Form
FOR QUOTATION ONLY
Use this simple order form to capture all
Please call for more clarification
the necessary specifications and components
Please fax back quote
needed for a quotation or a purchase (mark
which at right). Use it with or without a
APPROVED FOR PURCHASE
company purchase order. First time
Purchase Order #______________
customers may require credit approval.
No purchase order used
Print
Date: _____________________________
Today
Needed by: ________________________
INVOICING AND SHIPPING INFO:
Contact __________________________________________________________________________________________
Company ________________________________________________________________________________________
Invoice Address __________________________________ City/State/Zip ____________________________________
Shipping Address ________________________________ City/State/Zip____________________________________
Phone __________________________________________ Fax _____________________________________________
E-mail __________________________________________
Face
Live or Dead Shaft Modifications
LS = Live Shaft
i.e. grooved, plating,
QTY
Model
Length
Unit Price
Total Price
DS = Dead Shaft
shields
Purchase Subtotal
Be Sure To Specify:
Bearing shields (if needed)
Purchase Total
If elevated temperatures or other unusual
operating conditions exist
Quick Reference to
Bearing type (if different from our standard
Product Nomenclature:
low-friction bearings)
LW-400-125 x 60"
Shafts
Mounts
— 60" roll face length
Custom coverings or modifications
— bearings to fit a 1.25" diameter shaft
Coating or covering by others
— 4.00" nominal diameter
— LightWeight
1035 Breezewood Lane • Neenah, WI 54957-1026
Ph: 920/729-6666 • Fax: 920/725-9992 •