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Please print this page and reference diagram above to provide the following information:


D1: _____________ (2 3/8"-7" range)                                 D3:     2"    or    2 1/2"     Shank Diameter ( Circle One)


L1: _____________ (Drill Depth =/<12")                             L2:  ______________  Shank Length (=/<6")


Name:        _________________________________________________ Phone: _____________________________


Company:  _________________________________________________      Fax: _____________________________


Email: ____________________________________________________


Fax completed form to 979-836-7308. Your quote will begin upon receipt.