www.bench-tek.com

Workbench Order Form
*Environment		*Quantity

*Workbench Frame		*Frame Color
Workbench Dimension		Worksurface Type (choose only 1)
*Depth		*Standard Laminate
*Length		*ESD/Static Control
*Height		*Chemical Resistant
*Steel Leg Size		*Butcher Block
		*Stainless Steel
Workbench Edging Type (choose only 1)		Ball Transfer Surface
*Standard T-Mold		Note: can only be used with flat surface or platform
*Waterfall T-Mold		*Lower Crossmember Support
*PVC T-Mold		*Cleanroom Backer
*Self-Edge
*90 Degree Rolled Front Edge
*180 Degree Rolled Front Edge

*Overhead Riser Shelf		*Quantity
*Shelf Design		*Cleanroom Backer
1st Shelf Dimension		2nd Shelf Dimension
*Depth		*Depth
*Length		*Length
*Height		*Height
** Note: deduct 3 inches from overall height for clearance
Shelf Surface Type (choose only 1)		Shelf Edging Type (choose only 1)
*Standard Laminate		*Standard T-Mold
*ESD/Static Control		*Waterfall T-Mold
*Chemical Resistant		*PVC T-Mold
*Stainless Steel		*Self-Edge
Additional Options
Bottom Shelf		Bottom Shelf Type
Bottom Shelf Surface Type (choose only 1)		Bottom Shelf Edging Type (choose only 1)
Standard Laminate		Standard T-Mold
ESD/Static Control		Cleanroom Backer

Drawers
Qty	Position	Qty	Position
	Right (1) 6 inch		Right Set of (2) 6 inch
	Left (1) 6 inch		Left Set of (2) 6 inch
	Right (1) 12 inch		Right Set of (3) 6 inch
	Left (1) 12 inch		Left Set of (3) 6 inch
	Right Set of (2) 6" & (1) 12"		Right Set of (1) 6" and (1) 12"
	Left Set of (2) 6" & (1) 12"		Left Set of (1) 6" and (1) 12"
Adjustable Leg Height

Powerstrips
Qty		48in - 12 Outlets (6ft cord) 15 amp - 120V
Qty		15in - 6 Outlets (6ft cord) 15 amp - 120V
Bin Rails and Panels
Qty		Single Bin Rail
Qty		Double Bin Rail
Qty		18"L x 19"H Louvered Bin Panel
Qty		35 3/4"L x 19"H Louvered Bin Panel
ESD Mat
Qty Mat Only		Depth	Length
Qty Mat with Common Ground Cord		Depth	Length
Lighting
	Qty	48LAMP - 48 in Dual Fluorescent Lamp
	Qty	SM14D-6400
	Qty	SM21D-6400
	Qty	SM28D-6400
Additional Accessories
Qty		Qty
	Wire Management		Ground Kit
	Keyboard Tray		4-Station Air Manifold
	Adjustable Monitor Arm		5-Station Air Manifold
	CPU Holder		Casters
	Grommet Holes on Bench		Common Ground Cord
Contact Information
*Name:		Please have a representative call me
Title:		Please add me to the mailing list
Company:		Location:
Phone:		How did you hear about us?:
*Email:		Other Notes: