APPLICATION CHECK LIST
                                 
Date
         
Company name   Internal Use Only
Contact     SA#
Address     Quotation #
City & State   Ref. Project #
Zipcode     Sales Mgr
Phone          
            Fax    Email
                                 
                                 
Product Characteristics
Type of Product (name and general discription)                    
Describe
1. Viscosity   Specific Gravity Weight
2. Viscosity   Specific Gravity Weight
water based  
solvent based 
liquids
powders
thins during mixing
thickens    
shear sensitive  
temp sensitive
toxic
corrosive  
soluble    
Insoluble  
sticky/gummy
light/fluffy
                                 
                                 
Electrical
Voltage
 
 
 
                                 
                                 
Mixer
Mixing category
 mix/blend  
 agitation    
 dispersion    
 solids suspensions
 emulsify
 other
Desired Results (What measures will be used to determine high quality performance.)
Machine
Speed Control
 
 
Sweep
 
low speed W/ risers
Side Wipers    
 Bottom Wipers    
                                 
                                 
Tank
 
  Batch Size Total Volume
Bottom
  Top
Inside
  Finish
Outside
  Finish
                                 
Jacket Pressure (PSIG)        
Side
Bottom
Vacuum
Pressure   Temperature (F)
                                 
                                 
Ram
Ram Press Required
 
  Discharge Pressure     Discharge Height    
                                 
                                 
Space Constraints  (note any known space challenges)
Floor Space (L x W)   Height Restrictions Doorway Size (W x H)
                                 
                                 
Existing Processed Methods
Is this product currently being  processed? 
  Describe
Machine Type
Manufacturer   HP Batch Size Tank Dimensions
                                 
Process description and include what improvements do you expect with the purchase of new equipment?
Note any information important but not covered in above questions
                                 
DisperseTech LLC    
700 Conshohocken State Rd ● Penn Valley PA 19072    
PHONE 610-668-9500 ● CELL 215-806-1538    
E-MAIL steve@dispersetech.com  ●  Website www.dispersetech.com