Customer Information

Company Name:
Date:
Individual Contact:
Title:
Address:
City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississppi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Country:
Postal Code:
Telephone:
Fax:
Email:

A = in.
B = in.
C = in.
D = in.
E = in.
F = in.
G = in.

Machine Type:
Machine Manufacturer:
Model:
Location of Bowed Roller (where in the process)?:

Max Web Speed: fpm
Average Web Speed: fpm
Web Material: Board Paper Film Foil Other
If other, specify:
Web Thickness / Weight:
Web Tension: pli
Operating Temperature: °F
Bow Type:    Fixed Bow       Variable Bow
Mounting Type:       Foot      Flange
Covering:      Rubber (Std.)      Other
            If other, please specify:
Driven?:       Yes      No
            If yes,     Flat Belt       V Belt   Other
            If yes, how is it driven (pulley, pulley type, etc.):
If there is a presence of water, chemicals, solvents, grease, etc., please specify:

Other comments or information:

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