Customer Information:

Company Name:
Address:
City:		State:	Zip:
County:		Country:
SIC Code (up to 8 digits):
Key Contact:		Title:
Phone: (include area code)		Fax:
Email Address:		Industry:

Project Timing:

Proposal Required by:
Is project funded:	Yes No	If Yes, what is expected Purchase Date:
Type of Proposal:	Firm Budgetary (±10%) Order of Magnitude (±25%)

Material Information:

Product Name:
Bulk Density:	pcf (settled) pcf (aerated)
Specific Gravity (if known):
Particle Size Distribution:	% retianed on mesh	% retianed on mesh
	% retianed on mesh	% retianed on mesh
	% retianed on mesh	% retianed on pan
Particle Description:	Powder Flake Pellet Granule Other
Flowability:	Free-flowing Free-flowing w/ aeration Sluggish Flowing
Friable:	Yes No
	Moisture Content: %	Material Temperature:
If degradation is critical, state accepable level: % by weight on pan over virgin sample(s)
Characteristics:
Abrasive Hygroscopic Corrosive Explosive Toxic Sticky Smears
Bridges Adhesive Cohesive Fiberous		Temperature-sensitive at °F

Application Information:

Describe the process this material is used in:
Duty Cycle:	hours per day, days per year
Material Source:		Headroom below source: feet
Is material source continuous feed: Yes No
Material Destination:
Convey Distance:	feet Horizontal feet Vertical Elbows
Desired Convey Rate:	pounds per hour	Type of loading: Gravity Vacuum
Contact surfaces:	CS Epoxy-coated CS 304SS 316SS

Installation Site Information:

Installation Location:		Altitude: F.A.S.L.
Ambient Temperate Range:	°F to °F
Will equipment be installed:	1) Indoors or Outdoors	2) Portable or Fixed
Frequency:	Hz
3-Phase Power Available:	230/460 575 208 220/380 Other
Electrical Class:	NEMA 4 NEMA 7 NEMA 9
If NEMA 7 or 9:	Class Group Div.
Noise Limit:	dB-A
Existing Dust Collection:	Yes, ft²	None Available
Available Air Supply:	Yes, scfm @ psig	None Available

Miscellaneous Information:

Batch Accuracy : ± % or pounds, whichever is greater
Total batch time of mixer/blender: minutes
Time allowed to fill the mixer/blender: minutes	Mixing/blending time: minutes
Time between batches: minutes
If food application, specify finish of interior and exterior surfaces:
If cross-contamination is an issue, specify concerns:
If paint specification applies, describe or attach specifications: