Gear Pump Data Form for Quotation Melt Pump Data Form for Quotation Company Name Contact Name Street Address 1 Street Address 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Zip Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden Bahamas, The Bahrain Bangladesh Barbados Bavaria Belarus Belgium Belize Benin (Dahomey) Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso Burma Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Chad Chile China Colombia Comoros Congo Free State, The Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Denmark Djibouti Dominica Dominican Republic Duchy of Parma Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Grand Duchy of Tuscany Greece Grenada Guatemala Guinea Guinea-Bissau Guyana H Haiti Hanover Hanseatic Republics Hawaii Hesse Holy See Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin Mecklenburg-Strelitz Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau Nauru Nepal Netherlands, The New Zealand Nicaragua Niger Nigeria North Macedonia Norway Oldenburg Oman Pakistan Palau Panama Papal States Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia Poland Portugal Qatar Republic of Genoa Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg Yemen Zambia Zimbabwe Phone Number Email Address Product(s) of Interest General Purpose Melt Pump (EGP) Chemical / Adhesives Melt Pump (CIP) High Pressure Melt Pump (HGP) Fluorinated Polymer Melt Pump (FGP) Pump Rebuild Drop-In Replacement Pump: PSI or Maag, Witte, Nordson/Xaloy/Dynisco/Normag or Other Brand Type of Application or Product Made Material Melt Index SG @ Melt Temp (If Known) Output Rate Lb/hr or kg/hr lbs/hr kg/hr Fillers (enter None, if none) Filler Percent by Weight Process Temperature Deg. F or C F C Viscosity Viscosity Unit of Measure Pa.s (pascal seconds) P (poise) cP (centipoise) Inlet Pressure PSI or Bar PSI Bar Discharge (or Die) Pressure PSI or Bar PSI Bar Type of Heat Electric Fluid Heater Voltage if Applicable Heater Phase 1Ph 3Ph Melt Delivery Single Screw - Non-Vented Single Screw - Vented Twin Screw - Co-Rotating Twin Screw - Counter-Rotating Truck Vessel Tote Other Extruder Size Inch or mm inch mm Are Upstream and Downstream Detail Connection Drawings Available? Yes No Unknown Comments Send
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