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Form
Overhead and Suspended Permanent and Electro Magnets
Date
Customer
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Title
First Name
Last Name
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
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Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
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Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
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Greenland
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Guam
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Guinea
Guinea-Bissau
Guyana
Haiti
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
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North Korea
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Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
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Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
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Saint Martin
Samoa
San Marino
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Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone
*
Fax
Contact
MATERIAL
1. (a) Material
(b) Material Burden Depth
2. Material Density
3. Steel To Pick-Up
Steel Particle Size
Max. Steel Particle Size
MAGNET
4.
Suspension Position
Client May Indicate Preference
5. Position
Over Belt
Over Trajectory
6. (a) Manual Cleaning
(b) Self Cleaning
CONVEYOR
7. Width Of Belt
8. Speed Of Belt
9. Incline Of Belt
10. Capacity Of Conveyor
11. Degree Of Troughing Idlers
12. Material Of Head Pulley
13. Diameter Of Head Pulley
14. Head Pulley Type
PERMAG
ELECTRO
POWER AVAILABLE
15. 415v Three Phase Supply
16. 240v Single Phase Supply
17. (a) Other – Volts
17. (b) Other – Amps
OTHER
18. Ambient Temperature
19. Altitude Above Sea Level