Company Name:   Date: 

Address:

Contact:

Phone: Fax:

E-mail Address:

Type Of Truck Preferred:

Engine Power Source:  Gas   Diesel

Type of Transmission Preferred: Manual   Automatic

Will your 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   Drum Two   Drum Three

Length Of Cable Required For:  Drum One   Drum Two   Drum Three

Maximum Line Pull Requirements:
         Drum  one     1st layer   mean layer   full drum

         Drum two      1st layer   mean layer   full drum

         Drum three      1st layer   mean layer   full drum

Maximum Line Speeds:
         Winch one:   Winch two    Winch three

Cable To Be Provided And Installed By CESCO:  Yes    No

Wire Rope Type: 

         Galvanized Aircraft   

         6 x 25 IWRC

Operators Seat With Adjustable Reclining Back:  Yes   No     

Hydraulic Capstan, 5" Drum  Yes   No

Round Style Headache Ball With Top Swivel & Shurlock Hook: 100 lb  Yes   No     

Torpedo Style Headache Ball With Rod Cage: 175 lb.  Yes   No     

Gin Pole Storage Rack:  Yes   No

Lockable Gang Boxes:  Yes   How Many? No

Locking Hydraulic Tank Cap:  Yes   No

Load A-2-B Anti 2-Block System:  Yes   No

Additional Requirements, needs, or comments: