Laserfiche WebLink
CONVERSION ORDER FORM <br /> REQUIRED INFORMATION <br /> PLEASE PRINT CLEARLY - FILL OUT THE SECTIONS BELOW <br /> DISTRIBUTOR: SALES PERSON: P.O. .# <br /> EXISTING/OLD DISPENSER <br /> MANUFACTURER 01t4w': ' <br /> SERIES / MAKE / l✓�;,, ,� �' <br /> MODEL NUMBER <br /> THIS INFORMATION IS NEEDED TO DETERMINE NUMBER OF OFFSETS, IF ANY <br /> ��� <br /> ]j UDC SUMP <br /> I 5 f-BRAVO BOX? OR MANUFACTURER I.BNOTH <br /> SHALLOW PAN OR DEEP SUMP <br /> /1 <br /> WATER SPLASH OPENING: LENGTH n WIDTH <br /> OF ANCHOR BOLTS: LENGTH MOTH (/ <br /> [� WATEROPLASH t.IP <br /> DOEO THE UDC HAVE A WATERGPLASH LIP? IX I YES ❑ ND <br /> THIS INFORMATION DEFINES THE UDC SUMP OPENING AND DETERMINES FRAME DIMENSIONS <br /> NEW/REPLACEMENT DISPENSER <br /> MANUFACTURER <br /> SERIES / MAKE ',4/V �7% A.Y.tn CJ <br /> MODEL NUMBER <br /> THIS INFORMATION CONFIRMS COMPLETE PIPING OFFSET PROFILE, DISPENSER-SPECIFIC <br /> WATER SPLASH RUNOFF PROFILE, AND ACCURATE ANCHOR POINT LOCATIONS <br /> PM <br /> FAX WITH C ❑ NV- B Z ❑ ❑ ❑ ORDER <br /> / <br /> PHONE: 323-888-4133 FAX: 323-888-4123 <br /> 1PEiS. BRAVO SYSTEMS, INC - 2929 Vail Avenue - Commerce - CA - 90040 [%VWNF <br /> rrel�� Fax: 323/888-4123 . E-mail: info@sbravo.com . www.sbravo.com Conn-B200II Order Form <br />