Dispensing Application Questionnaire
First Name
*
Last Name
*
Company
*
Phone
*
Email
*
example@example.com
Fluid to be Dispensed
Name
Product Category
Select
Please Select
Adhesive
Epoxy
Technical
Food
Cosmetic
Pharmaceutical
Viscosity (cP)
Liquid similar to:
Please Select
Water
Shampoo
Honey
Toothpaste
Foaming characteristic
Yes
No
Particulates or Solids
Yes
No
Stringy characteristic
Yes
No
Crystallizing characteristic
Yes
No
316 Stainless Steel
Yes
No
Delrin
Yes
No
Teflon
Yes
No
PVC
Yes
No
EP
Yes
No
Viton
Yes
No
Buna
Yes
No
Kalrez
Yes
No
Other
Yes
No
Other
Dispensing Parameters
Volume (ml/shot)
Cycling Rate (shots/minute)
Dispensing Temperature (°C)
Filling Method
Please Select
Open top
Vacuum
Pressure
Recirculation loop
Pump Inlet and Outlet Fittings
Please Select
Swagelock
Saniclamp
Plastic Tube
Other
Size & Shape of Container
Pump Arrangement
Number of Pumps Per Machine
Pump Mounting
Pump mounting
Please Select
Independent
Pump Plate
Pump Wagon
On Machine
Infeed System Required
Please Select
Hopper
Pressure Tank
Other
Fill Nozzles Required
Please Select
Open tube
Positive shut off
Check valve
Other
Fill Nozzle Movement
Yes
No
Drives
Please Select
Pneumatic
Stepper
Servo
Controls
Please Select
Independent
From Host Machine
Special Support Systems
Other Information
Questions or Comments
Provide Sketch
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