| 1. | Model 50 (50 lb.) or Model 100 (100 lb.) |
| 2. | O.D.
of conductor, or O.D. of conductor and armor rods if applicable |
| 3. | Line Voltage |
| 4. | Quantity |
| 5. | Destination |
| 6. | Required Delivery Date |
| To Write: | NH INDUSTRIES, INC. 1003 E. 75th Ave. Denver, CO 80229 |
| To Call: | 1- 303-287-6634 |
| Fax Number: | 1-303-287-0081
|