Reiku Robot Custom Dress-Out Design Form


Simply fill out the form below and one of our highly trained sales representatives will contact you shortly.

    Fields marked with * are mandatory

    Customer Information
    Company Name *
    Contact Name *
    Phone Number * Ext:
    Email *
    Address *
    City, State *
    Zip *


    Job Description
    1. Job details: Make, model and specific cell location or name of the robot application *
    2. Approximate length of cable, hoses *
    3. What Axis is the dressing to and from? *
    4. Will you be needing mounting hardware and/or brackets? * Yes
    5. Will you be requiring installation? * Yes
    6. How many robots will be dressed for the project? *
    7.What date is required for the dress out? *
    8. Photo of the robot, including cable/hose termination area(s)
    9. Do you have a short video of the robot in motion? (helpful in the designing process) Yes (when our sales rep contacts you about this quote, they will ask you regarding the video)
    10. Additional notes, information



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