Name:

Company/ Organization:

Company Address

Phone:

Email:

1. Quantity of  Electric Drop Arms:

2. Approximate Arm Span Length(s):

Ft

Ft

Ft

Ft

3. Barrier Location:

City

State

4. Estimated Installation Date:

Month

Year

5. Site Installation and Electrical Infrastructure:

6. End User Category:

7. Estimated Cycle Rate:

Cycles Per Week

8. Is Backup Power Required:

Include Questions, Site Specific Information, and Additional Barrier Products of Interest

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