Company Name:   Date: 

Address:

Contact:

Phone: Fax:

Email:

Hoist will be used for:

Will hoist be used to lift personnel?  Yes   No

Do you require Manlift Certified Winches?  Yes   No

Number of drums required:  One   Two   Three

Size of cable required for drum:  One   Two  Three

Length of cable for drum:      One   Two   Three

Line Pull For Each Winch:
         Drum One        1st Layer   Mean Layer   Full Drum

         Drum Two         1st Layer   Mean Layer   Full Drum

         Drum Three      1st Layer   Mean Layer   Full Drum

Feet Per Minute & Maximum Line Speeds:
        Winch One        1st Layer   Mean Layer   Full Drum

         Winch Two         1st Layer   Mean Layer   Full Drum

         Winch Three      1st Layer   Mean Layer   Full Drum

Engine Power Source:  Gas    Diesel

Any Size Or Weight Restrictions?  Yes    No

Options
Operator's Console:  Yes   No     

Engine Heater:  Yes   No

Wire Rope: 

                 Installed:  Yes   No  

                Galvanized aircraft:  Yes   No

Hydraulic Capstan  5" Drum:  Yes   No     

Round Headache Ball:  Yes   No

Torpedo Style Headache Ball:  Yes   No     

Anti-2 Block Device:  Yes   No

Dillon Cable Speed & Load Tension Readout Fixture:  Yes   No

Secondary Kill Switch For Diesel Engine:  Yes   No

Dash Mounted Service/Warning Light For Hydraulic Return Tank Filter:  Yes   No

Lockable Vandalism Cover For Gauges:  Yes   No

Hydraulic Tank Heater:  Yes   No     

Custom Weather Cover:  Yes   No

Adjustable Umbrella Behind Operator's Console:  Yes   No

Operator's Seat With Adjustable/Reclining Back:  Yes   No

Tool/Storage Box:  Yes How Many?   No     

Picking Beam:  Yes   No

Extra Tie Down Points:  Yes   No     

Synthetic Hydraulic Fluid:  Yes   No

Engine Weather Housing Cover:  Yes   No

Trailer:  Yes   No