Current Date
January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008 2009 2010

Facility Name

Address


City

Contact #1 Name

Contact #1 Phone

Contact #1 Fax

Number of Machines Being Installed
Additional Outlets

System Type:
Aluminum Trim Wall System Sub Floor
Other

Floor Plan Available:
Yes No
(If yes please fax floorplan to 559-256-8100)

Is There a Fire Code That Will Inhibit Polyethylene Tubing
Yes No

Building Type :
Old New Under Construction Renovation

Structure Information

Walls
Concrete Block Insulated Sheetrock
Non Insulated Sheetrock
Other

Floor
Concrete Slab Supported Concrete
Wood Brick
Other

Is There Access To The Floor From The Underside?

Yes No

Rubber Wood
Other

Floor Covering
Carpet Rubber Wood Tile Linoleum Other

Drop Ceiling Concrete Slab
Wood Other

Is There Access to the Crawl Space Above the Ceiling For the Tubing?
Yes No

Yes No

Are There Any Columns or Beams in the Room That We Must Go Around?
Yes No

Is There a 115 Volt 20 Amp Dedicated Curcuit Outlet at the Compressor Location?
Yes No
If no, one will need to be installed for the compressor.

Compressor Location
With Equipment Storage Room
Other

Specify the Distance Between the First Exercise Machine to the Compressor:
Feet Inches

Doors:
36" Double Doors
Other
What Floor Will the Equipment Be Located?
Ground Basement
Attic Floor Number

If Not Ground Level, is There a:
Staircase Elevator

Is There a Step Ladder Available for Access to the Ceiling Area?
Yes No

Are All Work Areas Required for Installation, Accessible During Normal Working Hours?
Yes No
If no, please inform Keiser of any situations in the comments area.

Comments and Special Situations:

When Would You Like The Air System to Be Installed?

January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008 2009 2010 Time

( Please insure all the information is accurate before sending )
* Required Fields