Eastside Machine Company

Custom Machine Request

Please fill out as complete as possible.

* Name:

*Title:

*Company:

* City:

* State/Province:

*Zip/Postal Code:

*Phone:

Fax:

*E-mail:

Type of Machine requested:

Type of Coil to be run

Thickness of Coil:

Coil width:

Does coil require Embossing?

Yes No

Does coil require Perforation?

Yes No

Does coil require Hole Punching?

Yes No

Do you need Panel Cut-Off?

Yes No

Cut lengths/tolerance required

Do you need "flying shear" to cut while machine is running?
Yes No

Power capabilities (Volts, Amps):

Speed of machine (ft/min):

Do you need variable speed?

Yes No

Typical usage per day (ft/day):

How soon do you need the machine?

Any additional notes: