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Customers name ..........................................................................................................................................

Delivery address ...........................................................................................................................................

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Contact Tel. No. for delivery.
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Manual Roller Door

Width of opening (brick to brick}     .....................................mm

Height of opening  (floor to underside of lintel)      ...................................mm

Colour..........................................

Price quoted £.........................

Quantity........................
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Electric Roller Door

Width of opening (brick to brick}       ......................................mm

Height of opening  (floor to underside of lintel)       .....................................mm

Colour........................................

Price quoted £......................

Quantity......................

Motor Drive Unit looking from inside        * LEFT HAND SIDE *     or    * RIGHT HAND SIDE *

Extra remote handsets (two included) ..........................

External Manual Release Switch (Yes or No) ...............
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Please make cheques payable to Envirotek Services.  Thank you.

Fax or return this form to Envirotek Services, 307, Bolton Rd, Edgworth, Bolton, BL7 0AW.

Please sign and date............................................................................