Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Walk-in Description 

Size and Type 

Panel Thickness  (choose one)	4"5"	cooler freezer 

Overall Box Length HeightDepthIndoor Outdoor	

If combo specify Cooler  x Freezerx 

Membrane Roof	

Floor (check all that apply)	 		Cooler		Freezer			

			Recessed				

			Stainless				

			Floorless						

			4" Vinyl Screed				

			1/8" Alum Treadplate			

			Aluminum Angle				

Doors 

Hinged	x	Hinge LH RH	

Hinged	x	Hinge LH RH

Sliding	x	Slide LH RH

Sliding	x	Slide LH RH

Solid	x	Hinge LH RH	

Glass	x	Hinge LH RH

Framed Opening, Doors by others	specify others 

Finish/Interior

Cooler		        FR  BK  LF   RT    Freezer		FR  BK  LF  RT

Galvalume  	             	   Galvalume		 	  	

Aluminum	         	  	   Aluminum		 	  	

Stainless     	 	  	   Stainless  	 	  	

Prepainted Wht	 	  	   Prepainted Wht	 	  	

Embossed White	 	  	   Embossed White 	 	  	

Finish/Exterior

Galvalume  	         	  	   Galvalume		 	  	

Aluminum	         	  	   Aluminum		 	  	

Stainless     	 	  	   Stainless 		 	  	

Prepainted Wht	 	  	   Prepainted Wht	 	  	

Embossed White	 	  	   Embossed White 	 	  	

Accessories (Check all that Apply)

Outdoor rain hood Heated air vent Outside locking bar Viewport window

4' fluorescent lights Extra Vapor Proof Lights Cooler AV alarm

Freezer AV alarm Vinyl Strip Curtain Door Closer Digital Thermometer

Exterior ramp Interior Ramp 

Kick Plate  Size Location Aluminum Stainless

Refrigeration (Check all that Apply)

Self contained  Indoor  Outdoor RemoteTop Side  

Hermetic Semi-Hermetic Scroll Discus Pre-Assembled

Pre-Charged Line   Air Cooled    Water Cooled

Cooler Temperature at 	

Freezer Temperature at	

Ambient Temperature at	

Length of PCL Lines	

Refrigeration accessories	

Electrical Requirements	

Cooler Voltage		Cycle 		Phase	

Freezer Voltage		Cycle 		Phase