Your Name:

Title:

Company:

Address:

City:  State:   Zip:

Country:

Tel:   Ext.

Fax:

Best time to call: A.M. P.M.

E-mail address:

Preferred method of contact: Phone E-mail Fax

What is the wire diameter? (measured in inches with a wire gauge):
0.035  0.050   0.062   0.072  0.082   0.092

Number of strands per foot (pitch)?
(standard meshes):
72   54   48   42   32   27  24   15

(custom meshes):
52   51   34   25

What is the width of your belt? (measured in inches):

What is the length of the belt? (measured in inches):

Number of spaces (rectangular openings) across the width of the belt:

What is the edge configuration?
Single Loop Edge  Double Loop Edge  Flat-Flex® XT 

Do you have a specialty belt?
No  Compound  Aligned 

Belt Temperature (deg F):

Will you be FAXing a simple sketch of your conveyor circuit? Yes No
(Send FAX to 603-644-3600 attention Tech Services)