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Quote Request - Conveying Applications

Date:
Name:		Phone:
Company:		Email Address:

Quote Type:

Budget Firm Add-On

Length	Model	Belt Width	OAW / Roll Ctr.	Support & Elev.	Speed	Motor

Unknown	Unknown	Unknown	Unknown	Unknown	Unknown	Unknown

Type of Item Handled

Cartons
Wood Boxes
Tote Pans
Crates
Baskets
Pallets

Drums
Rolls of Paper
Rolls of Cloth
Bags
Bundles
Other

Size, Weight & Color of Packages to be Handled
(color is very important in EZLogic Applications)

Length (in.)	Width (in.)	Height (in.)	Weight (lbs.)	Color

Will there be shock loading?

Yes No

If Yes, height of drop:

Rate of Items Per Hour

items/hr OR Unknown

Total Live Load

lbs OR Unknown

Will conveyor be stopped/started under full load?

Yes No

If Yes, max # starts/minute:

Number of hours conveyor will be used

hrs per day days per wk OR Unknown

Will the conveyor be reversible?

Yes No

If Yes, # of times/minute:

Paint Finish

Special Motors or Drives

Is this a Powered Application? Yes No

Voltage:

110 208 230 460 575
Unknown Other

Type:

Unknown TEFC EE Easy Clean
Explosion Proof

Class Gp. Div.

Motor Phase:

Unknown Single Phase Three Phase

Hertz & Horsepower:

Unknown OR Hertz: HP:

Conditions Surrounding the Conveyor

Unknown
Excessive/Abrasive Dust
Mositure or Humidity
Oil

Corrosive Fumes
Operating Temp.
Other

Additional Data

Use this area to list any other requirements for this system or to further explain anything on this form:

Pallet Handling Information:

Does this application deal with pallets?

Yes - (Continue filling out the rest of the form)
No - (Skip to Submit My Application Data)

Describe Bottom of the Product

Smooth Flat Bottom
Runners
Other

If the product has runners, how are they positioned relative to the direction of travel?
Parallel
Perpendicular

Please Mark the Style of Wood Pallet Used


Double-Face Reversible	Double-Face Non-Reversible	4-Way Notched Stringer

4-Way Block	Double-Wing Reversible	Single-Wing Non-Reversible
Plastic (Must Have Sketch)

Sketch

I will Fax or Email a Sketch to HCM Systems
I have no Sketch