*Contact Name:	*Email Address:
Phone:	Fax:
Shipping Info: (For freight purposes)
Company Name
Address 1:	Address 2:
City, State Zip/Postal Code:	Country:
Your Stor-Deck Distributor's Name (If Known):

MEZZANINE INFORMATION
Overall Dimensions:
Width                                           X	Length             X			Deck/Floor Height
Mezzanine Vertical Clear Height (Floor to underside of beam) - (ONLY IF REQUIRED)
Number of Stairways (NOTE: Mid-Landing required for rise exceeding 12 ft.)			Type of Stairway Select Stairway Type BOCA (33 degree angle) OSHA (45 degree angle) IBC (International Bldg Code - 33 degrees)
Number of Landings (Allows parallel entrance & exit from side of mezzanine)
Number of Ladders (NOTE: Not recommended as primary means of egress.)			Type of Ladder Select Ladder Type Vertical Ships Ladder (68 degree)
Number of Loading Gates	Type of Loading Gate Select Loading Gate Type Drop Gate (Lift Out) Slide Gate Swing Gate Bi-Parting Swing Gate Mezzanine Safety Gate			Clear Width of Gate Opening
NOTE: If more than one type of gate is needed, please specify in the comments section.
Required Column Spacing:
Width                                           X	Length			Most Cost Effective
Type of Floor Select Type of Floor 3/4 inch Plywood over B-Deck (Most Economical) Resin Wax & Composite Wood Panel (Designed for Pallet Jack Use) Bar Grating Galvanized Bar Grating Galvanized Channel Grating Diamond Plate over B-Deck Concrete Ready Other (Specify)			If 'Other' Floor was specified
Floor Capacity:
125 PSF (Standard)                            150 PSF                            Other
Safety Railing and Kickplate (Lineal Feet) (Enter 0 for none)			Type: Select Rail Type OSHA - 2 rail BOCA - 3 rail IBC Picket Rail
Describe Application for Mezzanine Usage Select Mezzanine Usage General Storage - Hand Carried Items Inplant Office Support Pallet Storage - Hand Pallet Jack Used Manufacturing Equipment Support Platform Other (Specify)
Will a Pallet Jack be used on mezzanine floor?      Yes                No If 'Yes' enter approximate total load of pallet.
Describe Area Below Mezzanine
Standard Mezzanine color is GRAY. Specify if other color is needed.
Do you require a hot-dipped galvanized finish?        Yes                No
Do you need us to provide an installation estimate?               Yes                No