Company Information:

Company Name: Address:
Contact Name: City:
Phone: State:
Email: Zip:
Fax: Country:

Model Specific Questions:

Outer Radius
Inside Radius
Belt Centerline Radius
Frame Height
Bed Width
Outside Trim Width
Quantity
Product to be conveyed
Product size (LxWxH)
Product weight
Degrees of turn
Directions of flow (CW, CCW, Both)
Drive location (LX, CX, RX)
Speed at center line
Top of bed height
Support (Floor/Ceiling)
Drive furnished by (JanTec/other)
Comments