Dispensing Application Questionnaire
*Company:
*Contact Name:
Address:
Postal Code:
City:
State/Province:
Country:
*Phone:
Fax:
*Email:
*Required fields
1. Fluid to be Dispensed
Name:
Technical Product
Food Product
Cosmetic
Pharmaceutical
A. Physical Properties
• Viscosity:
Centipoise
Similar to:
Water
Shampoo
Honey
Toothpaste
• Solids Content:
Yes
No
• Special Fluid Properties:
B. Chemical Compatibility
• Metals:
316L Stainless Steel
Other:
• Plastics
Delrin®
Teflon®
PVC
Other:
• Elastomers
EP®
Viton®
Buna N®
Kalrez®
Other:
• Other Materials:
Alumina Ceramic
Zirconia Ceramic
Glass
2. Dispensing Parameters
• Dispensing Volume Range: From
ml to
ml/shot
• Cycling Rate Required:
shots per minute. Dispense time
seconds.
• Dispensing Temperature:
Room Temperature
°C or
°F
3. Pump Arrangement & Interface with Host
• Number of Pumps per Machine:
• Pumping Mounting:
On Machine
On Mobile Wagon
• Type of Host Machine:
Bottle Fill Line
Thermoformer
Vertical Form, Fill Seal Machine
Horizontal Form, Fill Deal Machine
Special Purpose Machine
4. Other Information