<p>DISTRIBUTOR QUOTATION FORM DATE: _ Registered job # DHSI 13 Silver Street, Rochester, New York 14611 TEL: 585-235-8543 FAX: 585-235-0431 Web: dhsi-seal.com Contact: Robert Rissone, President e-mail: [email protected] Request and Take-Off By: *CONTACT *Name of Job: *Distributor: *City/State: *Address: Contractor: *City/State: City/State: *TEL: TEL: *FAX: *ARCHITECT: *e-mail: *TEL: *necessary for quote A. #105 "Cush 'N' Seal" Frame Seals: Circle Color Choice: Off-White (OW) or Dark Brown (DUR) Frame Seals/Weatherstripping: Interior or Exterior QUANTITY SIZE # of entry rooms 3’-0 x 7’-0 (example) # of communicating (2 / opening) x2 = _ each # of Stairwell # of Others TOTAL SETS: _ $ B. #CS 36 Cap Sweep ex. 3’-0 $ _ at Entry, Connecting, Stair and other Circle Choice Off-White (OW) or Dark Brown (DUR) C. #CS 36 x AMU Cap Sweep $ _ with Allowance and Means for Undercut option (Entry) D. #AMDB3 Adjustable Mortise Door Bottom $ _ x SWE YES or NO x AMU YES or NO E. #AMDB3 x AMDB-CC $ _ Adjustable Mortise Door Bottom with Conversion Channel for HM doors F. #SSDB3 Surface Door Bottom $ _ x AMU YES or NO Cover Color: OW, Duro, AL or Champagne G. #SAS: “Secur-A-Seal” automatic door bottom $ _ Frame Color: Cover Color: OW, Duro, AL or Champagne H. #SAL: “Secur-A-Latch” Privacy Keeper finish $ _ I. #SPC Strike Plate Cover (for use with SAL) $ _ J. #SA-7: Self Adhesive Surface Astragal OW or DB 7’-0 $ _ K. #SA-8: Self Adhesive Surface Astragal OW or DB 8’-0 $ _ L. #AMA3 Adjustable Mortise Astragal $ _ M. # FT 2.75 Fire Threshold Black (ex. Entry) $ N. # FA/SB Frame Alignment/Security Brackets $ O. # HS 2.75 Fire Threshold Black (ex. Stair) $ _ P. # FS 5.50 Fire Threshold Black (Full Saddle) $ _ Q. # DP.25 Dust Plug (1 each for 12 doors) 12” $ _ R. ADD FOR FREIGHT: DHSI will calculate and fax return $ _ All freight costs are based upon estimate weight at time of quotation. Actual cost may vary at time of shipment. S. NY State TAX: $ * Buyer agrees to pay tax outside NYS direct to the taxing authority in the state where applicable T. DHSI will calculate and Fax return: GRAND TOTAL $ _ </p><p>TERMS: Net 30 from day of receipt of material. All quotes are in U.S. Funds. Past due invoices are subject to penalties as allowed by individual state codes. Delays in the formal acknowledgement of the Industry Guidelines and Recommended Clearances forms will delay shipment. The training materials and related forms are COPYRIGHT and it is agreed that they will not be duplicated, nor allowed to be duplicated by any other person or organization. They remain the property of DHSI. Use is for specific sites only and by the owner (Operations Manager) for training. Buyer agrees not to compromise the intended use of "Cush 'N' Seal" by using it as a frame seal with other manufacturer’s products. These terms and conditions preclude any terms and conditions as may appear on any P.O. issued by the buyer and/or user and is agreed upon by issuance of such P.O. Material supply only-not a labor subcontract-No retainage. This quote is good for 30 days from date of issue. Installation constitutes acceptance of the product. Consult DHSI for current production lead times. Distributors must agree not to mix our sealing systems products with other manufacturer’s sealing systems products, such as our frame seals with other mfg door bottoms. Accepted By: DOOR AND HARDWARE SYSTEMS, INC. Company: Date: Date: By: Date Material is Requested: DQFH-01</p>