Your Name______________________________________ Date_______________________________________

Company Name_________________________________ Tel #___________________________________________

Address_________________________________________ FAX___________________________________________

E-mail__________________________________________________________________________________________

Project_______________________________________________________________________________________

CONVEYOR DATA & SPECIFICATIONS

Belt: __ Fabric __ Steel Cable __ Other_________________________________________

Belt Width____________________________________ in.

Take Up: __Mechanical __ Gravity __ Hydraulic __ Other_________________________________________

Drive Motor: HP__________________________________ Belt Speed:______________________________________

Bearing Centers__________________________________

Tons Per Hour:___________________________________ Type of Material Conveyed:________________________

Center to Center Distance:________________________ Lift in Feet:______________________________________

Delivery Requested:_________________________________________________________________________________