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Quote Request Form

General Information

Company Name

Street Address

City:

State:

Zip:

Contact Name*:

Phone*: (###-###-####)

Email:

Fax:


Application / Product Information

Desire Proposal Deadline:

Products to be Handled:

Number of Products:

Name and Part Numbers:

Handled Product Dimensions:

Weight

Max:

Min:

Height

Max:

Min:

Width

Max:

Min:

Length

Max:

Min:

I.D.

Max:

Min:

O.D.

Max:

Min:


Facility Information

Environmental Factors (select all that apply):
Corrosive
Dusty
Abrasive
Explosive
Clean

Facility Temperature:

Norm. (65-85° F)

Hot (specify):

Cold (specify):

Available Electrical Utilities:
110V 1PH
230V 3PH
460V 3PH

Other (specify):

Air Pressure at Install Location:
80-90 PSI
90-100 PSI
100+ PSI

Other (specify):

Current Handling Methods:

Manual
Forklift
Crane

Robot
Other

Operation Data
Max. Number of Cycle/HRS:
Number of Shifts/Day:

Sequence of Operation

Max. Reach Needed (Inches from Center Line of Manipulator):

Min. Reach Needed (Inches from Center Line of Manipulator):

Distance to Bottom of Product at Lowest Position:

Distance to Bottom of Product at Highest Position

Where was the Measurement Taken From (i.e. Floor, Platform, etc.):


Addditional Notes

Message:

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