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CONVERSION ORDER FORM <br /> REQUIRED INFORMATION <br /> PLEASE PRINT CLEARLY - FILL OUT THE SECTIONS BELOW <br /> DISTRIBUTOR: SALES PERSON: P.13. # <br /> -7`1 <br /> EXISTINWOLD DISPENSER <br /> MANUFACTURER /( <br /> SERIE5 / MAKE �/�� � <br /> �Rf7v7 <br /> MODEL NUMBER <br /> THIS INFORMATION IS NEEDED TO DETERMINE NUMBER OF OFFSETS, IF ANY <br /> ��'�)j UDC SUMP <br /> - <br /> I/I�tlRAVO BOX? OR MANUFACTURER LENOTH <br /> SHALLOW PAN OR DEEP SUMP <br /> WATER SPLASH OPENING: LENGTH A/d 'J, WIDTH <br /> OF ANCHOR BOLTS: LENGTH WIDTH <br /> WATQRSPLASH 1.M <br /> DOE■ THE UDC HAVE A WATERHPLAHH LIP? JsJ YES 11 NO <br /> THIS INFORMATION DEFINES THE UDC SUMP OPENING AND DETERMINES FRAME DIMENSIONS <br /> NEW/REPLACEMENT DISPENSER <br /> MANUFACTURER <br /> SERIES / MAKE <br /> MODEL NUMBER <br /> THIS INFORMATION CONFIRMS COMPLETE PIPING OFFSET PROFILE, DISPENSER-SPECIFIC <br /> WATER SPLASH RUNOFF PROFILE, AND ACCURATE ANCHOR POINT LOCATIONS <br /> FAX WITH C ❑ NV- B 2 ❑ ❑ ❑ ORDER <br /> PHONE: 323-888-4133 FAX: 323-888-4123 <br /> PEtL �S. BRAVO SYSTEMS, INC - 2929 Vail Avenue - Commerce - CA - 90040 <br /> Fax: 3231888-4123 - E-mail: info@sbravo.com - www.sbravo.com Com-132000 Order form <br />