Name
Title
Organization
Mailing Address
Address (cont.)
City
State
Zip Code
Work Phone
FAX
E-mail
Scale Application
Conveyor #
Scale Model
Stationary or Portable	Stationary:   Portable:
Belt Width
Belt Length
Idler Spacing
Belt Speed (FPM)
Power (115 VAC, etc)
Capacity	Avg: Max:
Material
Material Size
Optional Equipment	Printer Material Management System
Comments