Note:
Input denoted by
*
are required.
General Information
Company name
*
:
Contact name
*
:
Street address
*
:
Phone number:
(
)
-
FAX number:
(
)
-
City, State, Zip
*
:
,
,
Email:
*
Application Information
Proposal Requested:
Select One
Budgetary
Firm
Date Proposal Needed:
Air pressure at install area:
Size of line at install area:
Maximum cycles per hour:
Shifts per day:
Electrical:
110
230, 3 phase
460, 3 phase
Product(s) to be handled:
Current handling method:
Weight (lbs)
Height
Width
Length
ID
OD
Maximum
Minimum
Maximum/minimum reach needed:
/
Inches from centerline of manipulator:
Distance to bottom of product at lowest position:
Distance to bottom of product at highest position:
Please indicate where mesurement was taken from (floor, platform, etc.):
Clearance Factors
Distance to lowest fixed overhead obstruction that cannot or would not be moved:
inches from floor.
Obstruction:
Mounting Preference
Select one:
Fixed Floor Mount
Fixed Overhead Mount
Mobile Overhead Bridge Mount
Portable forklift/pallet jack base
End Tooling Preference
Select one:
Hook
Expanding Probe
Gripper
90° Tilt
Vacuum
180° Tilt
Other
Special Handling Considerations
Grip area, pressure, temperature, other, describe:
Comments and Sequence of Operation
