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R/S Electric Motors Sales & Service - 1422 South 6th St., St. Joseph, Missouri 64501

*Name
*Company
*Address
*City, State, ZIP Code
Fax
*Phone
*Email
Motor Quote Requested:
Brand Name
Voltage
Motor HP
Frame Size
RPM
Phase
Enclosure
	Horizontal or Vertical
	AC or DC
Additional information for sales and service
Rush Service needed	Yes  No
Date Required  for Delivery
Hoist Product Quote Requested:
Product
Product code or  model#
Type of hoist	Chain   Air  Electric
Maximum capacity  (tons)
Standard Lift  (ft)
Lift Speed  (fpm)
Phase
Accessory	Rigid Hook   Chain Container   Extra Chain
Comments: