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    NOTE: IT IS IMPERATIVE THAT ALL THE INFORMATION ON THIS FORM IS PROVIDED FOR US TO DESIGN A CUSTOM SPACER TO EFFECTIVELY MEET YOUR NEEDS, AND ALSO TO PROVIDE YOU WITH AN ACCURATE QUOTATION

    Customer Information

    Company

    Address

    City

    State

    ZIP Code

    Contact Name*

    Title

    Telephone*

    Fax Number

    Email Address*

    Duct Spacer Information

    "A" TYPE OF SPACER
    MC - MODULAR CAPM - MODULE (Interlocking)MB - MODULAR BASE (Interlocking)

    "B" NOMINAL DUCT SIZE

    "C" TYPE OF DUCT
    A - Plastic Duct, Iron PipeT - Bell Spec AT 8546, Plastic Duct

    "D" DUCTS PER TIER

    "E" HORIZONTAL SEPARATION

    "F" VERTICAL SEPARATION

    QUANTITY

    Other pertinent information: