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 LOCKER INFORMATION 
 SURVEY

 

Some of our customers have told us that they don't always have all the data readily at
 hand to complete the online form when first visiting our web site.  They have requested
 some type of printable worksheet that could be completed prior to sitting down at the 
computer to enter information into the survey form itself.  In an effort to address that problem;
 we have added a link to a
PDF® version of this page using the Adobe® Portable Document
Format
.  You can print out the form using Adobe® Acrobat®
Reader, gather all the required
 information at your leisure, and return here fully prepared to enter and submit it to us.  

    In order to view and print the PDF® file, you will need to have Adobe® Acrobat®
 or Adobe® Acrobat® Reader installed on your computer.  Fast becoming the standard for
 internationally recognized document exchange, installation of Adobe® Acrobat® will allow you
to view PDF® files anywhere on the internet.  To download and install a free version of
Adobe® Acrobat® Reader, click on the banner shown below and follow the onscreen prompts.
 
 

         

View and print a blank Locker Information Survey form

 

 
 
        Important!!

 

Where we have given you the option of multiple choice answers, please  make your selection by using your mouse to click on the election box to the left of each line item. Multiple selections can be made within any category where multiple choices have been provided.

To avoid unnecessary delay, please provide as much information as possible in your initial submission.
An incomplete survey will normally require us to contact you by phone before processing your request. 
An answer of "I don't know" or "Unknown" is usually better than none at all.


When you have completed all required information, you can forward it to our Sales Department by clicking on the <Submit> button located at the bottom of the form.  Upon receipt of your completed survey, one of our Sales Representatives will promptly review it.  Based on your answers to key questions, we will either provide you with an immediate quote or contact you by telephone to obtain further information.

 


 

Items marked with a red asterisk are required fields!

 

SCHOOL/CONTACT INFORMATION
 

*

School Name:
* Street Address:
* City, State, Zip:  
* Name of Contact:

Your Title or Position: 

* Phone Number:
     Ext.  
Best Time to Call:

* FAX Number:

eMail address

      
 LOCKER INFORMATION

  *  Number of lockers you wish us to quote on: 
      Please enter the number of locker doors you have, i.e. 200 two-tier frames is 400 doors.
      
Exception
- Don't include top doors on two person lockers!

       Manufacturer:  (required if you want us to do any repair work)
      
This information can usually be found on the number tag or handle.  If the tags have previously been 
      replaced or the handle is not embossed with the name, call us and we will gladly help you.

  Republic
 Lyons
   Penco
   Interior
   Other (please specify below)   
          
         Additional Information: 

  * Style of lockers:       

 Singles
Two-Tier
3-Tier        4-Tier          5-Tier           6-Tier
Two Person
Duplex
Other (please specify below)
             

       Additional Information:

If you're unsure what type lockers you have, click here for pictures of common styles.

    * Are they recessed, extending from the wall (slope or flat tops), or totally free standing:

  Recessed
   Extending from the wall with flat tops On legs?
   Extending from the wall with slope tops On legs?
   Free standing On legs?
   Other (please specify below)
         
      
Additional Information:

      
*  

Dimensions   (W*x  H*x D): 
   
*Measured from the outside
        edges of the locker frames!

               

  *   Have they been painted before ?

   Yes
   No
   Some were . . . some weren't
   Unsure?

  *  If so, was it:  (check all applicable)

   Epoxy
   Enamel
   Latex
   Unknown
   applied electrostatically?
     . . . with a brush or roller?
         . . . . or by other means? (please specify below)
Other relevant information we should know about your lockers:

      Current paint color(s):  

     Desired paint color(s): 

     NOTE: Neutral base colors will almost always require a coat of primer followed by two full finish coats to 
      provide adequate coverage.  An additional charge will apply.  Some examples of neutral base colors are reds,
      yellows, oranges, most dark blues or greens, and wine or burgundy.   

Are there any
needed repairs?


General Comments:  

   
       

  


 

 

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