If you require a quotation on multiple pieces of equipment with different specifications either:
A) Contact us directly by calling 770-449-8810.
B) Print the blank form multiple times, complete relevant sections and fax it to us at 770-416-8460.
C) Submit a separate form for each piece of equipment.

Full Name:
Title:
Company:
Address Line 1:
Address Line 2:
Address Line 3:
City:
State:
Zip Code:
Country:
Phone:
Fax:
E-mail Address:
Application (Film, Sheet, etc.):
Information Required for Quotations:
Material Types:
Maximum Line Output:
Maximum output of the extruder recycling the scrap:
Maximum Linespeed:
Grooved Feed Section?	Yes No
Tangential Feed Throat?	Yes No
Maximum Scrap Rate:	lbs/hr kg/hr
Film Thickness:
Number of Winders:
How many edge trims?
Maximum edge trim width:	in cm
Where are they taken?
How many bleed trims?
Maximum bleed trim width:	in cm
Where are they taken?
Web Width:
Roll Scrap?	Yes No
Loose Scrap?	Yes No
Is Gravifluff required for fluff storage?	Yes No
Maximum Distance from Trim Pickup Point to Inducer:	Feet   Meters
Distance from Inducer Outlet to Grinder:	Feet   Meters
Number of Elbows:
Distance from Grinder to Refeed Machine:	Feet   Meters
Number of Elbows:
Additional asr® Request Comments: