Company:
Address:
City:
State/Province:
Zip:
Corotec rep:
Date quote requested:
Phone #:
Fax #:
Contact:

---

NOTE: This information section must be completed in full so that we can provide an accurate quotation.

Process equipment:
Treat on:	One side   Two sides
Width to be treated:
Treat on:	Top of web   Bottom of web
Min. & max. web width:
Web tension:
Typical production speed:
Max. production speed:

What is the main reason for treatment?:
Has your material been pretreated?:	Yes   No

	Material	Gauge	Additives	Dyne Level Req'd
1)
2)
3)

NOTE: If you are sending samples for evaluation in our lab, be sure that they are on a 3-inch diameter core, have a maximum width of 40 inches, and include 500 feet of film.

Comments:

FedEx or UPS account # for overnight sample return:
INSTALLATION INFORMATION
Will this system be installed in a hazardous area?	Yes   No
What plant voltage is available?	Volt     Phase
What is the plant air pressure?	PSI
SALES INFORMATION
Date quotation required:
What is the customer's estimated budget?
Type of quotation required:	Formal   Budgetary
Projected date of purchase:

Power supply type:	Full featured  Economy
Electrode type:	Fixed width Fully segmented