DO YOU HAVE A MAGNETEK ACCOUNT NUMBER? YesNo

FIRST NAME

LAST NAME

COMPANY NAME

EMAIL

PHONE NUMBER

COUNTRY Select One United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

STATE/PROVINCE Select One Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon

STATE Select One Aguascalientes Baja California Baja California Sur Campeche Chiapas Chihuahua Coahuila Colima Durango Guanajuato Guerrero Hidalgo Jalisco México Mexico, D.F. Michoacán Morelos Nayarit Nuevo León Oaxaca Puebla Querétaro Quintana Roo San Luis Potosí Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatán Zacatecas

POSTAL CODE

OEM/DEALER CONTACT INFORMATION: Name

OEM/DEALER CONTACT INFORMATION: Company

OEM/DEALER CONTACT INFORMATION: State

OEM/DEALER CONTACT INFORMATION: Postal Code

OEM/DEALER CONTACT INFORMATION: Phone

OEM/DEALER CONTACT INFORMATION: Email

CONTACT NOTES

EQUIPMENT DESCRIPTION

SPECIAL FUNCTIONS/NOTES

TRANSMITTER CONFIGURATION Pendant - No RadioTether (CAN-Bus) - No RadioStandard US - 300' Range - 902-928MHz Frequency - USA/Canada AcceptanceStandard EU - 300' Range - 433MHz Frequency - USA/Canada/EU Acceptance2.4 FHSS Type 1 - 500' Range - 2.4GHz FHSS 10mW Frequency - International Acceptance2.4 FHSS Type 2 - 1500' Range - 2.4GH FHSS100mW Frequency - International Acceptance2.4FHSS Type 3 - 2500' Range - 2.4GHz FHSS 200mW Frequency - International Acceptance900FHSS Type 2 - 1500' Range - 900MHz FHSS Frequency - USA/Canada Acceptance

TRANSMITTER/PENDANT Type Hand-Held Hand-Held Proportional Pistol Grip Bellybox Custom

CUSTOM TRANSMITTER/PENDANT TYPE NOTES

SPARE TRANSMITTER? YesNo

PROPORTIONAL TRIGGER FOR PISTOL GRIP YesNo

HOW MANY DUAL AXIS JOYSTICK CONTROLS?

HOW MANY SINGLE AXIS PADDLE CONTROLS?

HOW MANY TOGGLE SWITCHES?

OTHER SWITCHING? Potentiometers, rockers, etc.

WHAT SHOULD HAPPEN IF TRANSMITTER BATTERIES DIE, OR GOES OUT OF RANGE?

WHAT SHOULD HAPPEN IF THE E-STOP IS PRESSED?

IS TWO-WAY COMMUNICATION NEEDED FOR DATA FEEDBACK? YesNo

IF YES, WHAT TYPE OF INFORMATION NEEDS TRANMITTED?

CAN UMBILICAL CABLE? OPTIONS: No, Tether Length (standard 30') or Custom Length (please define)

RECEIVER CONFIGURATION: Voltage 12VDC 24VDC Other

RECEIVER CONFIGURATION: Voltage Other Define

RECEIVER CONFIGURATION: Engine Start Options: No, Yes (if yes, describe)

RECEIVER CONFIGURATION: Throttle Control Options: No, Yes (if yes, describe)

RECEIVER CONFIGURATION: Antenna Type Internal Ext. Whip 2 ft. Remote 8 ft. Remote Custom

RECEIVER CONFIGURATION: Antenna Type Custom Define

RECEIVER CONFIGURATION: Output Cable Options; None, 6' Pigtail, Custom (if custom, define). *Note: Consult factory for cable and connector options*

SPECIAL REQUIREMENTS: E-Stop Operation What should the outputs do after the E-Stop is pressed? Enrange’s Standard configuration is as follows: When an E-Stop, Low Battery, or a standard Power Down command is issued; the receiver immediately opens ALL relays.

SPECIAL REQUIREMENTS: Out of Range Operation What should the outputs do if there is a loss of link or the Transmitter or batteries die? Enrange’s Standard configuration is as follows: When the receiver has not received a valid RF data for 1 second, all relays except the MLC open. After an additional 2 seconds without RF data (3 seconds total) the MLC relay will open.

SPECIAL REQUIREMENTS Please indicate any special requirements (ex. special interlocks, time delays, any wishes you may have)

FUNCTION 1

FUNCTION 2

FUNCTION 3

FUNCTION 4

FUNCTION 5

FUNCTION 6

FUNCTION 7

FUNCTION 8

FUNCTION 9

FUNCTION 10

ADD 10 MORE FUNCTIONS? Yes No

FUNCTION 11

FUNCTION 12

FUNCTION 13

FUNCTION 14

FUNCTION 15

FUNCTION 16

FUNCTION 17

FUNCTION 18

FUNCTION 19

FUNCTION 20

ADD 10 MORE FUNCTIONS? Yes No

FUNCTION 21

FUNCTION 22

FUNCTION 23

FUNCTION 24

FUNCTION 25

FUNCTION 26

FUNCTION 27

FUNCTION 28

FUNCTION 29

FUNCTION 30

ADD 5 MORE FUNCTIONS? Yes No

FUNCTION 31

FUNCTION 32

FUNCTION 33

FUNCTION 34

FUNCTION 35

WILL YOU BE SUBMITTING A QUESTIONNAIRE FOR ANOTHER PRODUCT TO GO ALONG WITH THIS ONE? If yes, please share what other product questionnaire you will be submitting.