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Action Equipment Co., Inc.
P.O. Box 3100
1000 Industrial Parkway
Newberg, Oregon 97132
USA

Phone: (503) 537-1111
Fax: .....(503) 537-1117

Manufacturer of Vibratory Separators, Conveyors & Feeders

QUOTE REQUEST

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For additional information, please fill-in the following:

*	Full Name:
*	Company:
	Job Title:
*	Mailing Address:
	Street Address:
*	City:
*	State / Province:
*	Country:
*	Postal / Zip Code:
*	Telephone:
	Fax:
*	E-Mail:

Completion of this form will help Action design and engineer a system to meet your needs
Proposal Required:    BUDGET      FIRM
When do you need our proposal?  1-2 days 3-4 days 5-6 days 7-8 days 9-10 days 11-12 days 13-14 days		Delivery requirements?  3-4 weeks 5-6 weeks 7-8 weeks 9-10 weeks 11-12 weeks 13-14 weeks 15-16 weeks 17-18 weeks 19-20 weeks
MATERIAL SPECIFICATIONS
Material(s) to be conveyed, processed or screened:
Bulk Density:	lbs./ft³
Shape of Particles:
Maximum Piece Size:
Minimum Piece Size:
Material Properties:	Abrasive Bridge Forming Corrosive Dry Dust Forming Explosive Flaky Flammable Fluffy Fluid Granular Hardens Neutral Other Powdery Radioactive Sticky Toxic Wet	More:
Average Quantity of Material:	tph total input or ft³ / min.)
If Surges:	ft³ / min. Surge duration
Material Temperature:	°F
Moisture Content:	%
OPERATIONAL SPECIFICATIONS
Operating Hours:	hours per day
Operating Days per week:	days
Infeed Method:		Discharge Method:
Accuracy Requirement:
Conveyor Size Desired:	Width	Depth	Length
Power Supply:	AC	3-Phase	DC
	Voltage	Hertz
Available Room:	Headroom	Width	Length
Type of Mounting:	Concrete Anchors	Steel Supports	Embedded Steel
Installation:	Indoor	Outdoor
	Fixed	Moveable
Please describe your application and list special requirements: