Cyclonaire Technology Demonstration and System Proving Facility

Cyclonaire Test Request
Important - MSDS required for each material
***Material may be refused without MSDS***

Customer Data:

Today's Date:
Company:
Key Contact:
Address:
City:	State: Zip:
County:	Country:
Phone: (include area code)	Fax :
Email Address:
List Test Attendee(s):

Application Data:

Product Source: Destination:
'horiz. + ' V with 90-degree elbows
Convey Rate pph
Recommended Materials of Construction: CS 304SS Other

Material Data:

Material Name:
Bulk Density: pcf
Particle Size:
Moisture Content: %

Is Material: Hygroscopic Corrosive Abrasive
Explosive Toxic

Shipping Instructions:

Return Product to:
Attn:

Freight Terms:
Freight Collect or Pre-Pay & Add
Return Authorization #:

If Pre-Pay & Add:
Preferred Carrier
Account #

If no carrier specified Purchase Order #
Product Shipping Class

***Please Include Hazmat Symbol Information, If Required***