Company Name:*

Contact Name:*

Street Address:

City:

State: ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip:

Phone:

Email:*

Part(s) to be Fed

Part(s) Name:

Part(s) Number:

Part(s) Samples: No Yes 

Part(s) Prints: No Yes 

NOTE: Solid Models preferred.

Part(s) Condition: Oily Dry 

Part(s) Orientation:

Equipment Options

Feeder: Best Choice Vibratory Centrifugal 

Track: Vibratory Conveyor Gravity Track 

Sound Enclosure: No Yes 

Required DBA :

Base Plate: No Yes 

Hopper: No Yes 

Legs: No Yes 

Estimated r/s to Floor:

Application Specifications

Feed Rate per Minute/Per Track:

Number of Discharges:

Dimensions between Tracks:

Feeder Rotation: TBD Counterclockwise Clockwise 

Special Requirements: No Yes 

Describe Special Requirements:

Electrical Supply Volts/Hertz:

Escapement: No Yes 

Additional Comments: