Company name:

Contact name:

Phone number:

Email:

Design:

Version:

1. Is your Micro Market going straight across or is it L-shaped?

Straight L Shared

1.a. If it’s L-shaped, will your banks connect? Yes No

2. What is the height, width, and the depth of your breakroom?

3. What is the make & model of your coolers?

4. How many coolers are in your market?

4.a. What is the width* x height x depth of your coolers? (Left to Right)

Cooler 1

Width Height Depth

Cooler 2

Width Height Depth

Cooler 3

Width Height Depth

Cooler 4

Width Height Depth

Cooler 5

Width Height Depth

5. Do you want us to replace the cooler marquees?

Yes No

5.a. If so I will need the width x height of those marquees.

6. Do you need any cooler shelves, dividers, or product pushers for your Coolers?

Yes No

6.a. If yes, which products?
COOLER SHELVES PRODUCT DIVIDERS PRODUCT PUSHERS SMALL PRODUCT PUSHERS LARGE

how many?

7. Do you need any product pushers or product dividers for your snack shelves?

Yes No

7.a. If yes, which products and what sizes?

8. Do you want the inside walls to have matching graphics? (They come standard black) $75.00 per wall?

Yes No

9. Do you need any additional pegs or baskets? (includes 10 pegs and 2 baskets per slatwall or gridwall section.)

Yes No

If yes. which products and how many?

Pegs: 12” SLATWALL PEGS 10” SLATWALL PEGS 8” SLATWALL PEGS 6” SLATWALL PEGS 12” GRIDWALL PEGS 10” GRIDWALL PEGS 8” GRIDWALL PEGS 6” GRIDWALL PEGS Baskets: 24” X 12” X 4” 12” X 12” X 4” 12” X 12” X 8”

10.Do you need a liftgate for delivery? Yes No

11. If you have multiple banks, do you want each bank on a separate palette?
Yes No

12. Do you have an existing install date? (Typical lead time is 3-4 weeks)
Yes No

12a. If yes, what is your install date?

13. Do have any additional information you would like to add?