Company Name:

Address:

City:                                     State:           Zip:

Contact Name:

Telephone #:

Fax #:


E-Mail Address:

Current Use: ______Pallets ______Fiber slip-sheets ______Plastic slip-sheets

Load Weight: ______#Min. pallet wt. _______#Ave. pallet wt. ______#Max. pallet wt.

Double Stack: ______Yes ______No

Footprint of load or pallet: ______ wide x _______deep (40" w. x 48"d.)

Usage: ______ /per month (3,000/ per month)

Freezer App. ______ Yes ______ No

Recycle: ______ Yes ______ No

Push /Pull ______ Cascade _______ Brudi ______Long Reach

For more information on Polly Sheets contact us @ 800-763-9020 or visit our website @ www.pollysheet.com