POTENTIAL CUSTOMER QUESTIONNAIRE LIQUIDS

Product Information:
Product:	Liquid    Paste
Product Type:	Chemical    Food    Edible Oil Adhesive    Other
Liquid:	Actual Product:
	MSDS:
	Specific Gravity:
	WT per Gallon
	Viscosity: Low     Medium     High
	Hazardous: Yes     No
	Fill Temp:

Current Packaging of Potential Customer:
Liquids:	Plastic Drum     Steel Drum Fiber Drum     Plastic IBC Steel IBC     Corrugated IBC Bottle in Cage Other
Manufacturer:
Handling:	Bottom Handle     Top Handle
Container Dimensions (L x W x H):	x x
Capacity:	# of Gallons per Container
Fill Type:	Connection:
Discharge Type:	Connection:
Pallet Size (L x W x H):	x x    (if applicable)
Filling Height Restrictions:
Stacking Requirements:
Stacking Height Restrictions:
Annual Usage:	# of Gallons

Liners for Liquids:
Pillow:	Aseptic     Non-Aseptic
	Size (L x W) x
	Fill Gland Size:
	Discharge Gland Size:
	Type of Connections:
	# of Plys:   Thickness per Ply
Cube/Form Liner:	Size (L x W x H) x x
	Capacity: # of Gallons
	Fill Gland Size:
	Discharge Gland Size:
	Type of Connections:
	# of Plys:   Thickness per Ply
Tube/Open Top:	Size: Diameter  Length
	# of Plys:    Thickness per Ply
Other:

Additional Information:

How are you currently transporting your products?           Truck     Ocean Container     Rail     Other

Do you usually ship/receive full truckloads?   Yes     No

Do you use your own trucks?   Yes     No

Do you currently reuse pallets and packaging?   Yes     No

If yes, estimate on the quantities shipping/receiving per month/year:

Fill and discharge locations:

Are you experiencing any problems with your existing system that you would like to see improved ie: filling, discharging, handling, storage, cleaning or repositioning:

Custom Equipment Company Product Line

Applicable containers for Liquids:        PPE     PP     Flexdrum

Price Request:   Yes     No

Sample Request:   Yes     No

If yes, expected delivery date:

Contact Information:
* Company:
Contact:
Address:
City, State, Zip:
* Phone:
* Fax:
*E-Mail: