Please provide the following contact information:

            Name 
           Title 
         Company Work Phone 
  Street Address        FAX 
 Address (cont.)     E-mail 
            City   Web-Site 
  State/Province 
 Zip/Postal Code 
         Country 

Application Information: (Please complete as much as possible)

SELECT THE TYPE(S) OF EQUIPMENT YOU ARE INTERESTED IN:

(NOTE: To select  more then one, hold down the "ctrl" key and then select all that apply)  

  SELECT FROM THE FOLLOWING: SINGLE STAGE SYSTEM TWO STAGE SYSTEM THREE STAGE SYSTEM

1.  Manufacturing Process (Before Cleaning)

2.  Manufacturing Process (After Cleaning)

3.   Dimension (Smallest Part)      

4.   Dimension (Largest Part)       

5.   Weight of Heaviest Part         

6.   Weight of Lightest Part          

7.   Basket Size                           

8.   Production Rate (per Hour)   

9.   Any Blind Holes   Yes    NO   UNCERTAIN

10. Type of Soils (Check All That Apply)  

Water Soluble Lubricants/Oils

Insoluble Lubricants/Oils

Coolants

Dust

Chips

11.  Level of Soiling      Light     Medium     Heavy     Baked On     Hardened

12.  Dryness Required    Flash Dry Acceptable     Few Droplets Acceptable      No Droplets/No Film 

13.  Additional Comments / Notes: