DATE:
YOUR NAME:
MAILING ADDRESS:
CITY, STATE, ZIP:
EMAIL ADDRESS:
TOWN/STATE:
LOCATION:
CONTACT NAME:
TEL:
FAX:
READY TO BUY:	READY TO BUY NOW BUDGET THIS YEAR BUDGET NEXT YEAR
LENGTH:
	CLEAR SPAN C/C BEARINGS O/A
ROADWAY WIDTH:
MATERIALS:	A-588 WEATHERING A-572 PAINTED A-572 GALVANIZED
LOADING:	HS-25 HS-20 OTHER
RAIL:	THRIE BEAM NESTED W-BEAM W-BEAM OTHER
TOP HANDRAIL:	YES NO
DECK:	CORRUGATED WOOD STRIP OTHER
BEARINGS:	STEEL STEEL & NEOPRENE STATE STANDARD OTHER
ANCHORS:	SWAGED WEDGE OTHER
ABUTMENT TO ROAD HGT:
SKEW:
TRUSSES:	HANGING FLOOR BEAMS NESTED FLOOR BEAMS OTHER
SIDEWALK:
EXPANSION JOINTS:	ANGLE ON ANGLE BACKWALL PLATES STRIP SEAL COMPRESSION SEAL EXTEND DECK ONTO BACKWALL OTHER
APPROACH RAILS:
OTHER INFO: