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Is This Survey for a
[__] Seeburg or [__] Western Electric Instrument? (Please check appropriate box) |
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| Model: _____________________________________________________________ (Seeburg Model A, B, C, E, E Special, F, G, H, J, K, KT, KT Special, L, PGA,, "Greyhound," X, etc.) (Western Electric Model B or X (with Selectra attachment), "Derby," etc.) |
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| Piano serial number: _________________________ | |
| Piano stack number: _________________________ | |
| Type of piano plate: | [__] Haddorff (two piece, gold/black, open
pinblock). [__] Seybold (one piece, odd tuning pin pattern). [__] Gram (cloverleaf holes in lower part). |
| Pipe chest number: __________________________ | |
| Coin switch number: _________________________ (not patent numbers) | |
| Type of coin switch: | [__] Very early (vertical ratchet accumulator). [__] Early (semicircular "fencepost" accumulator). [__] Late (semicircular "single post" accumulator) in cast iron box. [__] Late (semicircular "single post" accumulator) in sheet metal box. |
| Motor Make & Model (if original motor): ________________________________________________________________ | |
| Type of art-glass: __________________________________________________________________________________ | |
| Rubber stamped date on the bottom of the piano hammers: ________________________________________________ | |
| Rubber stamped date on inside of bass or snare drum: ____________________________________________________ | |
| Comments: _______________________________________________________________________________________ _________________________________________________________________________________________________ |
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| Your Name: Mailing Address: Telephone No: E-mail address: |
______________________________________________ ______________________________________________ ______________________________________________ (_____)_________________________ __________________@__________________________ |
| Please send this form to: Art Reblitz P.O. Box 7392 Colorado Springs, CO 80933-7392 |