Home   Seamless Floor   Patch Kit   Repair Process   Testimonials   Estimate Request   Contact Info   E-Mail   "When you select a company to do a once in twenty year project, you want it to be right. Fortified Systems is that company. I can only hope that our company is as well respected and trusted in the food industry." Viacom/Baker's Square Corporation Randy Stone, V.P. Operations	Please take the time to fill out this form for a Estimate Request I.  CONTACT INFORMATION: COMPANY: ADDRESS: SHIPPING ADDRESS: CITY: STATE: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KN KS LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OR PA RI SC SD TN TX UT VA VT WA WI WV WY ZIP: PHONE: FAX: CONTACT(S): E-Mail: URL: POSITION: TYPE OF BUSINESS: II.  EXPOSURE CONDITIONS: NAME OF AREA: FLOOR EXPOSED TO: Select One Corrosion Water Impact Wear Oil & /or Grease Vibration Other CHEMICALS (CONCENTRATION & TEMPERATURES) pH RANGE: TRAFFIC FLOOR IS EXPOSED TO: Foot: Cart: Truck:   Please list Weight: TYPE OF WHEELS: Steel: Rubber: Composition:   Please List Size of Wheels: IMPERFECTIONS: Chipped: Rutted: Cracked: Other:  If other, please explain: STRUCTURAL MOVEMENT: HOW IS FLOOR CLEANED? TEMPERATURE OF FLOOR DURING PRODUCTION? III.  DESCRIPTION OF APPLICATION DIMENSIONS: TOTAL Sq. Ft. *If more than one area is subject to conditions of following list. COVING:   LF HEIGHT:  CURB/VERTICAL:   LF HEIGHT:   TYPE OF SUBSTRATE:   Concrete:   Wood:   Steel:   Other: TYPE OF TOPPINGS TO BE REMOVED: (Sq. Ft. Thickness) Resinous Flooring: Concrete Patch:   Paint:   Sealer:   Tile:   Asphalt:   Oil and Grease:   Metal:   Wood:   Other: Is substrate under topping:  Sloped to drain Flat Must Drainage/Pitch be Established?   Yes No Surface Conditions:    Smooth % Sm. Agg. Exposed Lg. Agg. Exposed Age of Current Floor:  Floor System Desired or Recommended:  Alternate Floor System:   Color:   Alt Color:  What is Desired Texture of Floor?  IV.  SITE AND FLOOR APPLICATION CONDITIONS Job Access:  Dock   Ground Floor   Upper Floor   Freight Elevator Area is:  Indoor Outdoors Temperature of Floor during application and cure  F or.. C Please list any Obstructions:  Please describe. Work to be done:  Weekday   Weekend   Holiday   Shutdown Total Available Time (hrs) for Floor Application and Curing (Be Specific as Possible)  Surface Prep:  Detergent Scrub   Shotblast   Scarify   Etch Dust Allowed:  Select One None Moderate Heavy Removal: (sq. ft.)  Jackhammer Sq. Ft.  Scabbler Sq. Ft. Keying:  Yes   No   Total Lineal Ft. LF Drain / Trenches  0 1 2 3 4 5 6 7 8 9 10 or more Type of Drain or Trench:  Water Available (temp. & pressure):   F C Compressed Air Available:  CFM PSI Electricity Available:  110V 220V 220V 3 phase 60 amps 440V 3 phase 60 amps Lift Truck Available:  Yes No Disposal of Debris:  On Site Other Solvent Safety General Notes:

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