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AUTOMATIC SCREWFEEDING SYSTEM QUOTATION REQUEST
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CUSTOMER INFORMATION
COMPANY		TODAYS DATE
CONTACT PERSON		PHONE NUMBER
FAX NUMBER		EMAIL ADDRESS
STREET ADDRESS		CITY
STATE		ZIP/POSTAL CODE
		COUNTRY
APPLICATION INFORMATION
ASSEMBLY NAME( P/N )		PART MATERIAL
OPERATION	HAND-HELD	PART FINISH

	FIXTURED/SLIDE
		MARRING CONCERN	YES NO
	STATIONARY
		ASSEMBLY ALIGNMENT	GOOD FAIR POOR
	MOBILE


		ALIGNED BY	OPERATOR
JOINT CHARACTERISTICS	FREE RUNNING		FIXTURE
	SOFT PULL UP		SCREW
	THREAD FORMING		SELF-ALIGNING

		HOLE CHARACTERISTICS	TAPPED
DRIVE POSITION	VERTICAL		DRILLED
	HORIZONTAL		PIERCED
	COMBO		PUNCHED
CURRENT FASTENING METHOD
FASTENER INFORMATION
HEAD TYPE	PAN	DRIVE TYPE	PHILLIPS
	ROUND		SLOT
	FILLISTER		INT. TORX
	TRUSS		EXT. TORX
	OVAL		POZI DRIVE
	FLAT		HEX RECESS
	HEX/WASHER		SQUARE RECESS
	OTHER		OTHER

		D=
		L=
		SD=
		OAL=


CAPTIVE WASHER		WASHER TYPE	PLAIN
ON SCREW?	YES		INTERNAL TOOTH LOCKING
	NO		EXTERNAL TOOTH
			SPLIT LOCKWASHER
			OTHER


SCREWDRIVER INFORMATION
WILL WE SUPPLY TOOL?	YES	MAKE & MODEL OF TOOL SUPPLIED OR DESIRED
	NO
NATURE OF DRIVER
	HAND-HELD	NUMBER OF ASSEMBLIES/HR
	FIXTURED/SLIDE	NUMBER OF SCREWS/ASSEM.
	ROBOTIC
	CUSTOM
DRIVER POWER SOURCE
	PNEUMATIC	TORQUE REQUIREMENT
	ELECTRIC	RPM

A Lou Zampini & Associates Company serving the world industrial markets

37 Conifer Drive, North Providence, RI 02904-3020

401-354 8878 (1-800 353 4676)

FAX 401 353 0113

Desoutter@cox.net