Contact:

Company:

Phone:

E-mail:

Address:

City:

State:

Zip:

Country

Industry:

Application:

Material(s) to be dispensed:

Material Description:

Flowability

Particle Size:

Sticky?

Yes No

Clumps?

Yes No

Segregation Issues?

Yes No

Hydroscopic?

Yes No

Hazardous?

Yes No

Pyrotechnic or Explosive?

Pyrotechnic Explosive

MSDS Sheets Available:

Amount (Weight) to be dispensed:

Weight Tolerance for each Dispense (+/-):

Describe Container to be filled:

Weight of Containers (Grams):

Required Throughput (Dispenses per Minute):

Special Concerns: