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CONVERSION ORDER FORM <br /> REQUIRED INFORMATION <br /> PLEASE PRINT CLEARLY - FILL OUT THE SECTIONS BELOW <br /> DISTRIBUTOR: SALES PERSON: P.O. # <br /> EXISTING/QLD DISPENSER <br /> MANUFACTURER <br /> SERIES / MAKE <br /> MODEL NUMBER <br /> THIS INFORMATION IS NEEDED TO DETERMINE NUMBER OF OFFSETS, IF ANY <br /> (��) UDC Sump <br /> I/I�if RAVO BOXY OR MANUFACTURER <br /> LLJJ LENGTH <br /> SHALLOW PAN OR OEEP SUMP <br /> l <br /> WATER SPLASH OPENING: LENGTH_' �, WIDTH <br /> OF ANCHOR BOLTS: LENGTH / ! WIDTH ( r/ <br /> WATERSPLASH I.IP <br /> DOEa THE UDC HAVE A WATERSPLABH LIP? YES ❑ NO <br /> THIS INFORMATION DEFINES THE UDC SUMP OPENING AND DETERMINES FRAME DIMENSIONS <br /> N EW/REPLACEMENT DISPENSER <br /> MANUFACTURER l_IL4�CZ <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 2000 ORDER <br /> PHONE: 323-888-4133 FAX: 323-888-4123 <br /> aPE[ <br /> S. BRAVO SYSTEMS, INC • 2929 Vail Avenue - Commerce • CA • 90040 ftsv"' <br /> BROD <br /> sYaFax: 323/888-4123 . E-mail: info@sbravo.com . www.sbravo.com (on%-B20000rJcTFori, <br />