110 Fifth Street   
West Elizabeth, PA 15088
Phone:  800-886-2533
Fax: 412-384-1968

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Application Information Sheet
PROFILE INFORMATION:      (*) are required fields

 (*) Email Address:

(*) Name:

 (*) Phone:

Company:

Fax:
1.  TYPE OF ITEM HANDLED
Cartons  Drums Wood boxes  Rolls of paper
Tote pans  Rolls of cloth Crates  Bags
Baskets Bundles Pallets  Other
             
2. GIVE SIZE, WEIGHT ALL PRODUCT TO BE HANDLED
   
  Size of Packages Weight
 Length Width Height
Min.
Avg.
Max.
  
3.  WILL THERE BE SHOCK  LOADING?
Yes
No

If so, from what height will package be dropped?

4. RATE OF ITEMS PER HOUR 
Enter rate here: 
5. TOTAL LIVE LOAD
Enter total live load (in pounds) here: 
lbs.
6. WILL CONVEYORS BE STOPPED AND STARTED UNDER FULL LOADS?
Yes
No
7. MAXIMUM NUMBER OF STARTS PER MINUTE
Enter starts here:
8. NUMBER OF HOURS CONVEYOR WILL BE USED DAILY
Enter hours here:
9. WILL CONVEYORS BE REVERSIBLE?
Yes
No
10. PAINT FINISH
Other than HYTROL green powder paint please supply 2" x 2" metal.    
11. SPECIAL MOTORS OR DRIVES
 
Brand
Voltage
Phase
Cycles

Standard Duty Totally Enclosed
Explosion Proof (Provide Class Group Div)
Energy Efficient
Wash down Duty
  
12. CONDITIONS SURROUNDING CONVEYORS

Excessive or abrasive dust
Moisture or humidity
Corrosive fumes
Ambient Temperature (Deg Fahrenheit)
Oil
Other 

 

  
* GENERAL CONVEYOR APPLICATION (IMPORTANT)