Integrated Solutions

Conveyor Application Worksheet

First Name:*

Last Name: (Surname)*

Job Title:*

Company Name:*

Address:*

City:*

State/Province:*

Zip/Postal Code:*

Phone:*

Fax:

E-mail:

PLEASE COMPLETE THE FOLLOWING INFORMATION AS IT APPLIES TO YOUR APPLICATION

1. PRODUCT INFORMATION:

Description/Material:

Dimensions:

Weight:

Total weight to be placed on conveyor:

Will there be shock loading?

Will the conveyor be stopped and started under full load?

Maximum Starts per minute

Will the conveyor be reversed? If so how many times per minute?

Product Temperature:

Parts per minute:

2. ENVIRONMENT:

Chemicals or fluids present:

Unusual ambient temperature conditions:

Other Concerns:

Wash down requirements:

3. APPLICATION:

Does product accumulate:

Product orientation on belt:

Other equipment interface information:

Any accessories or periphery equipment to be mounted to conveyor or stands:

4. CONVEYOR:

5. ELECTRICAL:

Input Voltage:

Other:

Controls Required:

Comments:

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