Custom Order Form

Ultra Seat Manufacturing Seat Assembly Worksheet

Make of Machine:		Model of Machine:
Make of current seat:		Model of current seat:
Mounting Pattern: (original mounting holes)
Side To Side:
Front To Back:
Notes:

Stroke of suspension:
Low profile 1-2"	Medium 2-3"	Regular 4-5"
Direct Air (from machine)	12 Volt Air	24 Volt Air
Mechanical	No suspension
Weight rating:
Standard Heavy Duty Height Adjustment
Other suspension requirements:
Notes:

Double locking Rails between seat and suspension		Single locking Rails between seat and suspension
Double locking Rails at bottom of suspension		Single locking Rails at bottom of suspension
Double locking Rails between seat and suspension and at bottom of suspension	Notes:

Backrest height:	Material:
Low profile Medium High Other: Emboidered Logo on Seat Back Rest Notes:	Cloth Vinyl Leather Other:

Mechanical Manual Air Notes:

Cloth Vinyl Leather Not Required Other:
Notes:

Right Hand Only Both Left and Right Hand Not Required

Other:
Notes:

	Black Belt	Orange Belt
	2" Retractable with safety switch	3" Non Retractable	2" Non Retractable
	3" Retractable	2" Retractable	Not Required
	4 Point (High back only)	3 Point (High back only)
Notes:

Fixed 16" length Adjustable 9"-25" Not Required Notes:

Seat cushion pad Not Required Other:

Notes:

Locking Forward and Back Not Required Extra Locking angles Notes:

Fixed Height: Adjustable Height: TO Notes:

IMAGE / PICTURE OF CURRENT SEAT / APPLICATION Limit your file size to under 2MB. Jpeg is the accepted file format.	IMAGE FOR EMBROIDERED LOGO Limit your file size to under 2MB. Jpeg is the accepted file format.