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Date:
Required Date: Quantity Required:
Customer: Contact Name:
Phone Number: Fax Number:
Ship To Address: Ship To City:
Ship To State: Ship To Zip:
Email Address:
1. Product Type
HDPE
PVC
Aerial
Rus Certification
2. Size
3/4"
1"
1 1/8"
1 1/4"
1 1/2"
2"
3"
3 1/4"
4"
3. Type of Pipe
Smooth In/Smooth Out
Smooth Out/Ribbed In
Ribbed In/Ribbed Out
Corrugated
4. Options
None
Pre-Lubed
Slit Corrugated
5. Wall Thickness
SCH 40
SCH 80
SDR 15.5
SDR 13.5
SDR 11
SDR 9
SIDR 15
SIDR 11.5
SIDR 9
Other
Specify:
6. Reel Size
66"
84"
96"
102"
114"
7. Reel Splits
One Way
Two Way
Three Way
Four Way
8. Color
Black
Orange
Red
Blue
Green
Brown
Gray
White
Yellow
Other
Specify:
9. Stripes
None
Black
Orange
Red
Blue
Green
Brown
Gray
White
Yellow
Other
Specify:
10. Pull Line
Empty
ROPE
FLAT LINE TAPE
FLAT LINE W/TRACER
1250# WOVEN POLY
1500# WOVEN POLY
1800# WOVEN POLY
2000# WOVEN POLY
2500# WOVEN POLY
1250# KEVLAR BLEND
1500# KEVLAR BLEND
1800# KEVLAR BLEND
2000# KEVLAR BLEND
TONABLE
Other
Specify:
11. ST-14 GA Split/Flanged Steel Conduit Quantity
ST-2.5 2/12" - 14GA Split Steel
ST-2.4 4" - 14GA Split Steel
12. RFS-Ribbed/Split/Flanged Steel Conduit Quantity
RFS- 3 3" - 12GA Split Steel
RFS- 4 4" - 12GA Split Steel
RFS- 5 5" - 12GA Split Steel
RFS- 6 6" - 12GA Split Steel
13. SHS Split/Hinged Split Steel Conduit Quantity
SHS- 3 3" - SCH 40 Hinged Split Duct
SHS- 4 4" - SCH 40 Hinged Split Duct
SHS- 5 5" - SCH 40 Hinged Split Duct
SHS- 6 6" - SCH 40 Hinged Split Duct
14. PVC Split Duct "Ductmate" Quantity
3 1/2" - Snap PVC Split Duct
4" - Snap PVC Split Duct
15. PVC Houserisers Quantity
723198 7/8" Dia x 5' with 7/8" Offset
723181 7/8" Dia x 5' Straight
723182 7/8" Dia x 5' with 18" Bend & Offset
723568 1 1/4" Dia x 5' with 1/2" Offset
723609 1 1/4" Dia x 5' with 7/8" Offset
723627 1 1/4" Dia x 2' U-Guard

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