SPECIFIC VACUUMING OR PNEUMATIC CONVEYING PROJECT QUOTATION REQUEST FORM (answer only questions that apply)

Please thoroughly fill in this form so we may properly propose a MAX VAC® Vacuuming or Pneumatic Conveying System for your application. Use website photo numbers to help describe your project. Please note: Headings with an * are required items to fully process your request.

Application: Vacuuming Pneumatic Conveying

Mr. Mrs. Ms. Miss

*First Name: *Last Name:

Title:

*Company Name:

*Address:

*City: *State: *Postal Code:

Country:

*Telephone Number: Ext. No. Fax Number:

*E-Mail Address:

1.	Please describe your MAX VAC® application using: the metric system or the U.S. Imperial system
2.	List our website photo numbers which might apply to your project:
3.	Your application, e-mail / fax or mail specs:
4.	*Material(s) to be conveyed:
5.	Characteristics of the material: (e.g. wet, dry, hot, sticky, hydroscopic, fibrous, granular, abrasive, free-flowing, bridges easily, electrostatic, explosive, acid, etc.)
6.	*Required conveying rate if applicable: (metric tons , U.S. tons ,liters, gallons, cubic feet, or other measure per hour)
7.	Material degradation a concern? yes  no
8.	*Maximum approximate horizontal pneumatic conveying distances: meters   feet
9.	*Maximum approximate vertical pneumatic conveying distances: meters   feet
10.	*Maximum material particle sizes:
11.	Average material particle sizes:
12.	Material bulk weights: kg per liter   lbs per cu. ft.   density
13.	Material moisture contents: (as a %)
14.	Maximun Material temperature: °C   °F
15.	Description of systems required/or e-mail/fax/mail specifications & drawings: A. Roll end-dump hopper system. Roll end-dump hopper yardage capacities: 1/4, 1, 1-1/2, 2, 3 B. Bottom-dump hopper system. Material container volume required: Preferred method of product discharge: Batch dump, Continuous C. Other system; please describe:
16.	How you wish the vacuumed material disposed/processed, after capture.
17.	Available powersupply: Volts, Phase, Hertz.
18.	*Is compressed air available? Yes, No ...If yes, what pressure is available? mbars   psi
19.	MAX VAC® location: Indoor, Outdoor
20.	Altitude: meters above sea level   feet above sea level
21.	Please describe any additional details which we should be aware of:

Additional Questions for Fixed Manifold System (if required):

1.	Total number of pickup points:
2.	Number of drop points:
3.	Number of persons vacuuming simultaneously:
4.	In order to best serve you, please e-mail/fax a plant layout sketch.
5.	Silo/Bin/Bunker: Fill, Empty

Optional Special Requirements (if required):

1.	Explosion/hazard proof, NEMA
2.	Towable In plant, Towable Over-the-road Ground clearance requirement: (centimeters / inches)
3.	Diesel Engine drive LPG Engine drive Gasoline Engine drive
4.	HEPA filtration
5.	Noise specification Required decibels @ 1 meter from unit:
6.	Intercept hopper. Please describe:
7.	Scaling specification. Please describe:
8.	Paint specification. Please describe:

Comments:

*Please indicate purchase time frame for your application:
Immediate Within 6 months Within 1­2 months Not known

*Please advise us where you found us? Choose from following: Alta Vista AOL Dogpile Excite Google GoTo HotBot Infoseek Lycos MSN WebCrawler Yahoo Thomas Register Thomas Register On-Line Other

We use AutoCAD 2000 and Microsoft Office 2000 software. Please e-mail any files or drawings that will allow us to better serve you. Thank you for your interest in DeMarco MAX VAC Corporation products. We will respond promptly upon receipt of your request. Please call us any time at 815-344-2222 (Worldwide) or 800-262-9822 (U.S.A.).