Conveyor Request for Quotation Form

Please complete all pertinent information in the Request for Quotation Form below to help us provide a conveyor quotation tailored to your specific application.

Specifications of Conveyed Material
Primary product being conveyed:
Material Temperature
Secondary product being conveyed:
If this is a machining operation describe: Grinding Drilling Milling Turning Boring	Machine name, model, type:
Material density:	lbs./cu.ft.
Minimum piece size:
Minimum piece / bundle size:
Is Material coated:	Yes No
If yes, what is the coating?
Is foreign material being conveyed with product (sand, etc.)?	Yes No
If yes, identify and specify approximate proportions:
Is material compressible?	Yes No
Are fines present? Give volume and % of fines, also approximate particle size:
Does product have an irregular shape and size, give detailed description of product make up, include sample:
Conveyor Design Criteria
Pounds per hour of product conveyed: Hours per day of operation:
Average capacity in pounds per hour:
Surge load ( design) capacity in pounds per hour:
Operation cycle: Continuous Intermittent
If intermittent: Number of cycles per hour: Operating time per cycle:
Type of installation:
Floor Mounted Pit Mounted Tank Mounted Other Machine Mounted Caster mounted Supports by other
Note: If conveyor is pit, tank or machine mounted, supply data such as pit details, tank details or machine opening and all other data necessary for proper conveyor design.
Quench application? Yes No
Note: If yes, supply type of quench, temperature and floor line relationship to tail shaft for lube fitting location. (Also check for quench additives; caustics, etc. Give percentages.)
Coolant application Yes No
Type: Water Oil Water-soluble oil other
Coolant tank Yes No Coolant pressure required: GPM of coolant conveyor must handle: Coolant clarity required from conveyor: micron
Note: Check for coolant additives; are they caustic, etc? What is concentration, if present.
Method of Loading
Uniform Metered Batch Other
Explain in detail how material is loaded on conveyor:
Note: If fed by a piece of equipment, identify equipment:
Does material drop from a height onto belt? Yes No
If yes, free fall distance in feet:
Does material slide onto belt? Yes No
If yes, distance it slides and angle
Method of Discharge
Explain in detail what the conveyed material discharges into (ie hopper, trailer, etc.)
Note: If conveyor feeds a piece of equipment, identify by name and model number: and e-mail a drawing to: mpresti@jorgensenconveyors.com or fax to 262-242-4382
Is product discharge controlled? Yes No
Metered Cycled As fed Other
Equipment Location
Describe environment equipment operates in:
Surrounding temperature range: F° C° –
Outside, exposed to elements Inside, protected from elements
Both inside and outside
What portion outside?
Conveyor Type
Metal Belt Drag Flight Magnetic Screw Carousel Live Roller Loader Shuttle Flattop Turntable Slat Walking Beam Wire Mesh Other
Conveyor Application
Dimensions A. Load Section B. Casing Height C. Discharge Height D. Discharge Length E. Pit Depth F. Conveyor Width G. Over-All Length H. Height Above Floor
Customer Special Requirements
Motor to be wired for: Volts Phase Hertz
Unusual temperature at motor F° C°
Unusual temperature at controls F° C°
Controls: By others By Jorgensen Indoors Outdoors
Type of Controls: Manual Starter Magnetic Starter
Type of enclosure: Mounted Shipped Loose
Wired? Yes No
Control voltage at push button:
Reversing (Jog Reverse) Reversing (Run Reverse) Non-Reversing
Paint Preference: Machinery Gray Vista Green Other
Commercial equipment preference? Yes No
Motor: Reducer: Bearings: Controls: Others:
If not covered above, describe in detail the function this conveyor is to perform for the customer.
Quotation is for: Budget Firm Project
Important Note:It is extremely important to provide our engineers with as much of the above requested information as possible; and as accurately as possible. Failure to do this could result in the misapplication or improper design of your conveyor.
Name Company Name
Address City State Zip
Phone -- Fax -
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