Name: _________________________________
Company: _______________________________
Position: ________________________________
Mailing Address: __________________________
City: ___________________________________
State/Province: ___________________________
Zip: ___________________________________
Country: ________________________________
Telephone Number: (Area Code) ____  _________
Fax Number: (Area Code) ____  ______________
Email Address: ____________________________

Reel Information:

Quantity Needed: __________________________
Part Number: (if needed) ____________________
One Way Usage?   Yes   ___
                          No    ___
Maximum weight to be placed on reel: ___________
Flange Diameter: ___________________________
Traverse Length: ___________________________
Barrel Diameter : ___________________________
Overall Traverse Length: _____________________
Arbor Hole Diameter: ________________________
Drive Pin Hole Diameter: ______________________
Drive Pin Hole Distance (center-to-center) :______
Start Hole Diameter: ________________________
Finish Hole Diameter: ________________________
Finish Hole Distance (center-to-center) :________
Material that will be placed on reel:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

Comments:
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

Moorecraft Fax Number: Fax: 252.823.2228