Your first step to have Total Seal Spray on lining installed in your dump trailer or dump truck is to fill out the Application/Warranty Data form below and submit to Total Seal. If your company is not required to pay sales tax, please click on the next page button at the bottom of this page, fill out the tax exempt form and return it with the Application/Warranty Data.
TOTAL SEAL APPLICATION/WARRANTY DATA
419-334-2761 419-334-8313 FAX 419-355-0661
Application Information: Date: __________________
Customer Information:
Company ________________________________________
Company Contact _____________________________________________________
Company Address _____________________________________________________
City _______________________State ____________________ Zip_____________
Phone # ______________________ Fax # _______________________________
Customer Referral: Web_____ Trade Show _____ Magazine Ad ____ Other User ____
Name of Other User ___________________________________________________
Body/Trailer Information: Manufacturer ___________________ Date_________________
Body/Trailer Serial No. _____________________________________________
Body Material _____________Steel __________________Aluminum
Body Heated ____yes _____no Length of truck/trailer body_______________
Straight box: _______1/2 Round box: _______1/4 Round box ______
Materials Hauled ___________________________________________________
Materials Temperature Range ___________ Degrees to __________Degrees
Materials Description/Size ____________________________________________
Material Dumps per day ______________________________________________
Application comments:
Floor condition: Dips ________ Depth ________" Thin _______ yes ____ no ____
Category to be applied: Light Duty ___ Medium Duty___ Heavy Duty___ Extreme Duty___
Customer Signature__________________________________________________
Total Seal is a trademark of R & D Sales & Service, Inc.
Multiple units at discounted price credited to last unit done.
Copyright © 2004, R & D Sales & Service, Inc.