Company:

Name:

Address:

City: State: Zip:

Phone: Fax: Email:

Product Characteristics:

Material to be handled (not trade name):

Operation Requirements:

Type of container (steel drum, carton, etc.)

How is the container handled (Lift Truck, Pallet Jack, Conveyor, Roller)

Unusual operating conditions (high temp. zone, dirty atmosphere, etc.)

Specify

Duty cycle: Continuous hrs. Intermittent: On time Off time

Construction Details:

Deck size requirements, if any: Length Width Height

Construction Material: Mild Steel Stainless Other

Special features required: (explosion proof, clamping arrangement, etc.)

Specify:

Power Supply:
Pneumatic	P.S.I. C.F.M. available	Supply Controls
Electric	Voltage Phase Cycle	Supply Controls
Notes:
Enter Code: