CHASE COVER 2 HOLES ORDER FORM DATE- NAME- PHONE# PO/JOB- MATERIAL- Select Material STAINLESS STEEL GALVANIZED COPPER BLACK BROWN WHITE DARK BRONZE PRIMER 1) LONG SIDE- 2) SHORT SIDE- 3) LONG SIDE- 4) SHORT SIDE- COLLAR HEIGHT- Select Collar Height 1 In 2 In 2.5 In 3 In 3.5 In 3.75 In 4 In 4.5 In 4.75 In 5 In 5.5 In 6 In 6.5 In 7 In 7.25 In 8 In 8.25 In 8.5 In 8.75 In 9 In 9.5 In 10 In 10.5 In 11 In 11.5 In 12.25 In 13 In 13.5 In 13.75 In 14 In 14.25 In 14.5 In 15 In 15.5 In 16.25 In 16.5 In 17 In 18.75 In 12.5 X 16.5 In 13 X 17 In SKIRT HEIGHT- Select Skirt Height 1 In 2 In 2.5 In 3 In 3.5 In 3.75 In 4 In 4.5 In 4.75 In 5 In 5.5 In 6 In 6.5 In 7 In 7.25 In 8 In 8.25 In 8.5 In 8.75 In 9 In 9.5 In 10 In 10.5 In 11 In 11.5 In 12.25 In 13 In 13.5 In 13.75 In 14 In 14.25 In 14.5 In 15 In 15.5 In 16.25 In 16.5 In 17 In 18.75 In 12.5 X 16.5 In 13 X 17 In RUSH + $50 DRIP EDGE- YES NO COLLAR A SHAPE- Select Collar Shape ROUND RECTANGLE SQUARE LOOSE COLLAR COLLAR B SHAPE- Select Collar Shape ROUND RECTANGLE SQUARE LOOSE COLLAR COLLAR A SIZE- Select Collar A Size 1 2 2.5 3 3.5 3.75 4 4.5 4.75 5 5.5 6 6.5 7 7.25 8 8.25 8.5 8.75 9 9.5 10 10.5 11 11.5 12.25 13 13.5 13.75 14 14.25 14.5 15 15.5 16.25 16.5 17 18.75 12.5 X 16.5 13 X 17 COLLAR B SIZE- Select Collar B Size 1 2 2.5 3 3.5 3.75 4 4.5 4.75 5 5.5 6 6.5 7 7.25 8 8.25 8.5 8.75 9 9.5 10 10.5 11 11.5 12.25 13 13.5 13.75 14 14.25 14.5 15 15.5 16.25 16.5 17 18.75 12.5 X 16.5 13 X 17 COLLAR A LOCATION SIDE A1 TO COLLAR- SIDE A2 TO COLLAR- SIDE A3 TO COLLAR- SIDE A4 TO COLLAR- SHORT- LONG- COLLAR B LOCATION SIDE B1 TO COLLAR- SIDE B2 TO COLLAR- SIDE B3 TO COLLAR- SIDE B4 TO COLLAR- STORM COLLARS- YES NO PIPE SIZE A- Select Pipe Size 1 2 2.5 3 3.5 3.75 4 4.5 4.75 5 5.5 6 6.5 7 7.25 8 8.25 8.5 8.75 9 9.5 10 10.5 11 11.5 12.25 13 13.5 13.75 14 14.25 14.5 15 15.5 16.25 16.5 17 18.75 12.5 X 16.5 13 X 17 PIPE SIZE B- Select Pipe Size 1.000 2.000 2.500 3.000 3.500 3.750 4.000 4.500 4.750 5.000 5.500 6.000 6.500 7.000 7.250 8.000 8.250 8.500 8.750 9.000 9.500 10.000 10.500 11.000 11.500 12.250 13.000 13.500 13.750 14.000 14.250 14.500 15.000 15.500 16.250 16.500 17.000 18.750 12.500 X 16.500 13.000 X 17.000 S.C. FLANGE- Select S.C. FLANGE 1.00 2.00 2.00 3.00 3.50 3.75 4.00 4.50 4.75 5.00 5.50 6.00 6.50 7.00 7.25 8.00 8.25 8.50 8.75 9.00 9.50 10.00 10.50 11.00 11.50 12.25 13.00 13.50 13.75 14.00 14.25 14.50 15.00 15.50 16.25 16.50 17.00 18.75 12.50 X 16.50 13.00 X 17.00 LOOSE COLLARS- YES NO CORNER BOLTS- YES NO HOSE CLAMPS- YES NO
