EHC - The World Leader in Escalator Handrails

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	Order D-Flector Safety Brush

CUSTOMER INFORMATION

Customer Name:		Region:
Order Date:	/ /	Ship Date:	/ /
Branch ID #:		Contract or Service Order #:

UNIT INFORMATION
Escalator Make:		Escalator Model:
Escalator Rise:	inches* mm*	Escalator Incline:	degrees
* If you don't know your exact rise, fill out a D-Flector Field Survey Form to calculate the proper dimensions and submit in addition to this order form		Balustrade:

# of D-Flector Kits Required**:		Finish of Brush Holder
** Use a new order form for any additional escalators that are not the same make, model and rise as indicated above		Finish of Brush Holder

OTHER PRODUCTS
Handrail Cleaner	Trial Size 12 Oz. 1 Gallon Quantity
Handrail Polish	Trial Size 12 Oz. 1 Gallon Quantity
RapidRail Installation Tool

CONTACT INFORMATION
Invoice Address:		Ship To Address Same or:
Ship Via:

Requester's Name:		Title:
Telephone #:		Fax #:
Email Address:
Notes:		Box Markings:
I would like my order confirmed by: Phone Fax Email