Application Worksheet
Step 1 of 2: Submit
Tell us what you are dispensing
Your Name
*
Your Company Name
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Your Email
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Your Phone
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Address
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City
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State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Florida
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Hawaii
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Illinois
Indiana
Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
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New Hampshire
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New York
North Carolina
North Dakota
Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
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Country
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What is the fluid?
What is the Viscosity (cps)?
What is the Specific Gravity?
What is it comparable to? (i.e., gel, paste, water)
Does the viscosity change in relation to temperature?
Yes
No
Does the fluid contain any suspended particles?
Yes
No
If yes, please answer the following three questions: What are the particles?
What is the particle size?
Can the fluid be heated to improve the dispensing or metering process?
Yes
No
If yes, to what maximum temperature (Celsius)
What is the density of the liquid? (grams/cc)?
Does the fluid have entrapped air or other gas (contain bubbles)?
Yes
No
Can the fluid be degassed under vacuum to eliminate entrapped bubbles?
Yes
No
Are there any handling or environmental concerns? (MSDS required)
Yes
No
Are there any specific materials not compatible with the liquids being dispensed?
If dispensing, what volumes of fluid need to be dosed?
If metering, what is the flow rate range in milliliters per minute?
What is the accuracy requirement ?
How many parts per minute do you need to fill?
Onto or into what is the dispense occurring?
How will the dispenser be triggered?
Manually
via PLC
RS 232
Other
Additional Information
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indicates required fields