Filler Upgrade Questionnaire, Long Form

Required Fields
Customer Name:
Company Name:
Company Address:
City:
State:
Zip:
Country:
E-mail:
Phone:
Fax:

Describe the type of filler to be upgraded:

Air Packer
Auger Packer
Impeller Packer
Net Weigh Scale
Box (Gaylord)
Bulk Bag
Open Mouth Drum
Open Mouth Drum w/liner

List manufacturer and Model Number if available:

Product Information

Check the types of products to be filled on this equipment:

Granular
Powder
Pellet
Spherical
Other:

List the number of fillers you wish to have upgraded at one time:

List the TOTAL number of fillers you wish to upgrade:

List all pneumatic/electrical devices used on your filler:
(examples include: Buld, Dribble, Bag Clamp, Butterfly or Single gate, Bag chair, Exhaust, Auger Fwd,Rev, Settler, Ready, and Discharge)

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12.

Environmental Information:

The standard filler upgrade is priced for a non-rated area, and includes mild steel painted construction and NEMA 4X fiberglass enclosures. Options are available for wet, corrosive, and hazardous locations. Please note your specific requirements below.

NEMA 12 (std. system)
NEMA 4 (wash down, dust tight)
NEMA 4X (wash down/corrosion resistant)
NEMA 7/9 (explosion proof)

For NEMA 4 and 4X applications, please note specific finish or material requirements:

For NEMA 7/9 applications, please check the specific area classification that applies:

Class I, Division 1
Class I, Division 2
Class II, Division 1
Class II, Division 2

Group:

Options and Accessories:

Options shown below can be used on any combination of filler controls:

STPR Statistical printer package: Prints each unit weight and/or summary production reports.

Remote Product load allows data from a PC or PLC to be up-loaded to controller

Special or Customized bag placer interfaces

When you press the SUBMIT button below, this completed form will be automatically E-mailed to Thompson Scale Company, and we will generate a detailed proposal based upon the information you have included in this questionnaire. We will also be happy to make suggestions, and work with your company to solve any special applications problems unique to your production line.

Thank you for taking time to complete this questionnaire and for visiting our Web Site!