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Belt Free Conveyor Application Form

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Application Form Instructions

Please complete as much of the form as possible. This will minimize un-necessary delays and allow us to get back to you faster with the correct conveyor solution.

Application Form

CONTACT INFORMATION      (* = required)
Customer: * Email: *
Contact: * Phone: *
Address: Fax:
City:      State :       Zip:

Conveyor Application Data:
Material to be conveyed:
(parts, press scrap, chips, etc.)
Can you provide samples?
Size of material Max: in/mm   Min: in/mm 
Rate of production:
(pcs or lbs/hr.)  
Wet or dry:  If wet, describe liquid
Coolant or oil flow: GPM
Conveyor to be submerged:
Describe how material will
be fed into conveyor:
Conveyor will discharge into:
Max. temp. of material:
Material demagnification required:
Legs required:    adjustable    casters
Available Voltage:
Paint Color:
Additional Notes:
Conveyor Type:

Conveyor Dimensions
W: Width  (6" minumum, 2" increment)      
A: Infeed Length  (12" minimum)   C: Discharge Length
B: Overall Length   D: Discharge Height

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