| * indicates a required field |
| Company Information |
| Company: * |
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| Quote Due Date: |
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| Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Country: |
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| Telephone: * |
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| Fax No.: |
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| Name: * |
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| Title: |
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| E-Mail: * |
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| Copy To: |
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| Title: |
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| E-Mail |
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| Project Name: |
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| 1. Application |
| Application: |
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| Unit of Measures: |
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| 2. Process |
| Describe your process |
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| 3. Materials To Be Conveyed |
| Materials To Be Conveyed: |
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| Avg. Particle Size: |
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| Max. Particle Size: |
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| Bulk Wt.: |
Lbs./Cu. Ft |
| Material Degradation a Concern? |
Yes No |
| Moisture Content as a %: |
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| Probe Required: |
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| Characteristics of material: |
dry
wet
hot
sticky
fibrous
abrasive
electrostatic
acid
oily
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| Maximum Material Temperature: |
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| 4. Conveying Rate |
| Required Conveying Rate per hour |
Please Specify Units(tons, liters, gallons etc...) |
| Max. Conveying Distance: |
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| Horizontal: |
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| Vertical Up |
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| Vertical Down |
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| No. of Turns |
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| Elevation of Jobsite |
feet above sea level |
| 5. Hose Diameter |
| Preferred Hose Dia.: |
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| 6. Questions for Fixed Manifold System |
| Piping Required: |
Yes No |
| Piping Layout Attached: |
Yes No |
| Multi-Vac To |
size pipe
supply pipe
install pipe |
| Total Number of Pick Up Points: |
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| Total Number of Drop Points: |
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| Number of operators at same time: |
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| Silo/Bin/Bunker: |
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| 7. Electrical |
| Electrical Service: |
Please Specify Volts, Phase, Hertz |
| Explosion Proof NEMA Classification: |
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| Powered By: |
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| Compressed Air Available: |
Yes No |
| psi: |
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| 8. Hopper System |
| Description of Hopper System Required |
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| Product Discharges: |
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| Other Type of System, please describe: |
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| What happens to material after it is collected: |
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| Vacuum Power Pack located: |
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| Similar To Model or Photograph No.: |
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| Add any details we should be aware of: |
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| 9. Vacuum |
| Vacuum to be Towable: |
Yes No |
| Towable: |
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| Ground Clearance: |
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| 10. HEPA Filtration |
| HEPA Filtration: |
Yes No |
| Noise Specification: |
Yes No |
| Required Decibels @ 3 feet: |
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| 11. Surface Preparation |
| Special Surface Preparation: |
Yes No |
| Specification: |
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| 12. Paint |
| Special Paint Required: |
Yes No |
| Specification: |
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| 13. Special Features |
| Intercept Hopper: |
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| 14. Specifications |
| Specifications Required: |
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| 15. Base Price Special Equipment |
| Special Equipment To Be Included In Base Price: |
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| 16. Optional Special Equipment |
| Special Equipment To Be Included As Optional Items: |
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| 17. Delivery Requirements |
| Shipping, Unloading, and Installation Considerations: |
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| Smallest opening equipment passes through: |
Please Specify wide x high |
| Headroom limitations: |
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| Floor load limitations: |
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| Floor space limitations: |
Please Specify wide x deep |
| 18. Purchase Time Frame |
| Please indicate a purchase time frame for this application: |
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| 19. How did you find us? |
| Please advise how you found us: |
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enter the 5 character security code. |
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request new code |
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