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Name

Address

Building/Company

Phone

Fax

Email Address

# of elevators?

State Reg #

What kind?

Passenger

Freight

# stops/floors?

Capacity

Are you under contract now?

No

Yes

Is there power to the building?

No

Yes

Is there power to the elevator?

No

Yes

Are there any State Violations on the elevator?

No

Yes

If yes, please fax a copy of violation letter.

Notes

Request a Quote

Repairs

MAINTENANCE

MODERNIZATION

INSTALLATIONS

STATE VIOLATIONS