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Ultimate Order Form
All
*
marked fields are mandatory.
Partner Details
Surveyor or Partner Contact Name
*
Date
*
Partner Order Reference
*
Partner Business Name
*
Contact Email Address
Fulfilment Method
*
Delivery
Collection
Install Only
Install & Maintenance
Delivery Address
Building Name/Number
*
Street
*
City
*
County
*
Postcode
*
Telephone
*
User and Usage
Is the end-user present?
*
Yes
No
Estimate number of trips per day
Ensure all measurements are entered in millimetres.
1m = 1000mm.
A
Seat to head height
mm
B
Seat to foot height
mm
C
Back to knee length
mm
D
Back to foot length
mm
Weight
kg
Height
mm
Minimum Seat Width
Inner (440mm)
Middle (495mm)
Outer (530mm)
Disability/Condition
Product Options
Model
*
Platinum Ultimate (120kg/19st)
Platinum Ultimate Heavy Duty (160kg/25st)
Platinum Ultimate Rail Only (120kg/19st)
Platinum Ultimate Rail Only Heavy Duty (160kg/25st)
Region
American (US)
Australian (AU)
Dutch (NL)
French (FR)
German (DE)
Italian (IT)
Scandinavian (SE)
Spanish (ES)
United Kingdom (UK)
Charger
AU
EU
UK
US
Seat Swivel Option
Manual
Power
Additional Remote Quantity
Intermediate Charge Points
Please mark any extra charge points on the drawing you provide.
1st
Intermediate Charge Point Location - Step Number
Add Charge Point
User Facing Direction
Upward
Only compatible with power swivel. Not available with first step start.
Downward
Only compatible with power swivel.
Sideward
Rail Colour
*
RAL 9002 Standard
RAL Other
If other please specify:
*
Underfloor Heating
*
No
Yes - Lower Level
Yes - Upper Level
Yes - Lower and Upper Levels
Upholstery Colour
Beige
Red
Blue
Grey
Black
Rail Position on Staircase
*
Select rail position (from bottom of staircase looking up)
Left Hand External
Rail on outer wall
Right Hand Internal
Rail on inner wall
Left Hand Internal
Rail on inner wall
Right Hand External
Rail on outer wall
Bottom of Staircase
*
Rail Start
Standard
First Step
Overrun
A
*
mm
Minimum rail length 500mm
B
*
mm
Distance from first riser to obstruction
Bottom of Staircase Rail Position
*
Standard
90° Wrap
Other Angle
°
180° Wrap
Other Angle
°
Top of Staircase
*
Rail Finish
Standard 100mm Overrun
Reduced Intrusion 0mm
Overrun
A
*
mm
Minimum rail length 100mm
B
*
mm
Distance from last step to obstruction
Top of Staircase Rail Position
*
Standard
90° Wrap
Other Angle
°
180° Wrap
Other Angle
°
Staircase Measurements
Survey Type
*
Manual
Digital
Number of Risers
*
1st Riser Height (a)
*
Vertical Height (b)
*
Horizontal Length (c)
*
Nose to Nose (d)
*
Angle (e)
*
Minimum Width (f)
*
Stringer Width (g)
1st Flight/Fan
Flight or Fan
*
Flight
Fan
Number of Risers
1st Riser/Step Height (a)
mm
Vertical Height (b)
mm
Horizontal Length (c)
mm
Nose to Nose (d)
mm
Angle (e)
°
Minimum Width (f)
mm
Stringer Width (g)
mm
Add Flight/Fan
Total Number of Risers
*
Number of risers in entire staircase
Total Height Measured
*
Staircase height from floor to top riser
mm
Measurements Validation
Pythagoras from previous measurements.
1st Flight
Calculated Nose to Nose (D)
mm
Average Rise
mm
Average Go/Tread
mm
Add Flight
Bulkhead Measurements
Overhead Height Restrictions
1st Bulkhead
Riser Number
Height (H)
mm
Offset (O)
mm
Add Bulkhead
Upload a Sketch, Drawing or Pictures
*
All drawings and measurements assumed to be taken to stringer (unless specified).
Additional Information
Notes/Special Instructions
I have read and agree to the
Terms and Conditions
and confirm that the information I have provided is accurate and complete.
Date
*
Submit Order
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