(1) piece equipment bracket ordering

1 Piece Equipment Bracket Ordering Form
Rev. A
Havis Equipment Brackets secure a wide range of control heads into our consoles. If you cannot find a listing of
a specific control head, look at the universal 2 piece equipment brackets for a solution. To find a two piece
bracket, you will need the width and height of your equipment. See web site link to determine bracket set needed.
If a customer desires a one piece (1P) equipment bracket, please contact a Havis Sales Representative to see if
we can help. Not all brackets requests will be granted due to quantity and popularity of control head.
If a one piece (1P) bracket request is approved, a loaner / sample control head must be shipped to:
Havis, Inc.
75 Jacksonville Road, Warminster, PA 18974
Attn: Engineering Department
** This form must be filled out and included with the shipment of the loaner control head **
Account / Customer Name: ___________________________________ Account No: ________________
Contact: _____________________________________________________________________________
Return Ship to Address: ________________________________________________________________
City: __________________________________ State:__________ Zip Code: ____________________
Phone Number: _______________________________________________________________________
E-mail: ______________________________________________________________________________
End users departments name: ___________________________________________(for sales history only)
Please fill in all that apply to your control head:
Manufacturer: _________________________________________________________________________
Model No: ____________________________________________________________________________
Dimensions: Control Head Height: ___________________ Control Head Width: _____________________
List other control head model numbers that are the same size / design: ____________________________
When Havis, Inc. receives loaner control head, we will design a one piece (1P) bracket and manufacture
prototypes. Once design is complete, the loaner control head will be returned with two (2) new equipment
brackets. Please allow 3 - 4 weeks for design.
Note: Make sure the information supplied above is correct.
If you have any questions about your equipment, please call our Sales / Customer Service Department.
Signature: _________________________________________________ Date:______________________