Company Name
Street Address
City:
State:
Zip:
Contact Name*:
Phone*: (###-###-####)
Email*:
Fax:
Desire Proposal Deadline:
Products to be Handled:
Number of Products:
Name and Part Numbers:
Handled Product Dimensions:
Weight
Max:
Min:
Height
Width
Length
I.D.
O.D.
Environmental Factors (select all that apply): Corrosive Dusty Abrasive Explosive Clean Other
Facility Temperature:
Norm. (65-85° F)
Hot (specify):
Cold (specify):
Available Electrical Utilities: 110V 1PH 230V 3PH 460V 3PH Other
If Other (specify):
Air Pressure at Install Location: 80-90 PSI 90-100 PSI 100+ PSI Other
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.):
Message:
Security Question: What day comes after Sunday*:
