10072020_PriceList_1.1

APPLICATION INFORMATION SHEET

DATE ________________________________________ DEALER ________________________________________ ________________________________________ SALESMAN ________________________________________

CUSTOMER ________________________________________ ADDRESS ________________________________________

________________________________________ ________________________________________

1 Length

2 Model

3 Belt Width

5 Support & Elev.

6 Speed

7 Motor

4 OAW & RLR. CTR.

TYPE OF ITEM HANDLED ____ Drums

____ Cartons ____ Rolls of Paper ____ Rolls of Cloth ____ Bags ____ Bundles ____ Other____________________

15 CONVEYOR WILL BE USED Hrs. per Day _______ Days per Week _______

____ Wood Boxes ____ Tote Pans ____ Crates ____ Baskets ____ Pallets

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GIVE SIZE, WEIGHT AND COLOR OF ALL PRODUCTS PRODUCT SIZE WEIGHT LENGTH WIDTH HEIGHT

WILL CONVEYORS BE REVERSIBLE? Yes___ No___ If so, how many times per minute? _____________________________

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COLOR

PAINT FINISH State color if other than standard Hytrol Green Powder Paint.

10 WILL THERE BE SHOCK LOADING? Yes____ No___

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_________________________________________________ _________________________________________________

SPECIAL MOTORS OR DRIVES

Brand__________________ Voltage ___________________ Phase__________________ Cycles ___________________ __________ Totally enclosed __________ Explosion proof(Class____Gp.____Div._____) __________ Energy Efficient __________ Easy Clean

11 RATE OF ITEMS PER HOUR____________________

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CONDITIONS SURROUNDING CONVEYORS

__________ Excessive or abrasive dust __________ Moisture or humidity

12 TOTAL LIVE LOAD

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__________ Corrosive (type____________________) __________ Operating Temperature __________________ __________ Oil __________ Other _________________________________

____________________lbs.

WILL CONVEYORS BE STOPPED AND STARTED UNDER FULL LOAD? Yes___ No___

GENERAL CONVEYOR APPLICATION (IMPORTANT) ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ PLEASE SUPPLY SKETCH FORM REVISED JANUARY, 2003

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14 MAXIMUM NUMBER OF STARTS PER MINUTE ________

PRICELIST | 01022019