QUESTIONNAIRE FOR CROWN BOTTLE FILLERS

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Thank you for visiting our web site. For a preliminary price quotation, please fill out the form below. Please remember that all questions are vital and should be answered entirely. The questions marked with an * are required.

UNIVERSAL PACKAGING MACHINERY CORPORATION

965 SHADICK DRIVE - ORANGE CITY, FLORIDA 32763 USA

TELEPHONE: 386-775-2969 or 800-351-8263 (USA, EXCEPT FL.) - FAX: 386-774-4900

*DATE:

*COMPANY:

*ADDRESS:

*CITY:

*STATE:

*COUNTRY:

 ZIP OR POSTAL CODE:

*PHONE NUMBER:

*FAX NUMBER:

*SEND QUOTE TO:

 ADDRESS IF DIFFERENT:

 CITY,STATE,ZIP IF DIFFERENT:

 COUNTRY IF DIFFERENT:

 PHONE IF DIFFERENT:

 FAX IF DIFFERENT:

CROWN BOTTLE FILLER:

*MODEL OF FILLER:

*NUMBER OF VALVES:

*NUMBER OF CAPPING HEADS:

 SERIAL NUMBER:

*TYPE OF FILLER: PINT
QUART
2 LITER
OTHER

OTHER:

*TYPE OF VALVE: STANDARD
SUPER
HIGH FLOW
SUPER FLOW
CASCADE
MARK V
MARK VI
OTHER

IF OTHER:

*DOES FILLER HAVE CENTERING DEVICES? YES
NO

IF YES, MANUFACTURER AND TYPE:

CENTERING CUP PART #:

SEALING RUBBER PART #:

*O.D. OF VENT TUBE: 1/4 INCH
5/16 INCH
11/32 INCH *O.D. OF BODY & TUBE ASSEMBLY:

*DIMENSION "W", CHECK ONE: (SEE DRAWING #1)

2 - 3/16 INCH (STANDARD/SUPER)
2 - 5/16 INCH (HIGH-FLOW)
2 - 1/2 INCH (SUPER-FLOW)
??????

??????:

*MEASURE LENGTH OF PRESENT VALVE BODY & TUBE ASSEMBLY. DIMENSION "L" SHOULD BE ONE OF THE FOLLOWING:

6 INCHES
8 INCHES
10 INCHES *MEASURE DIAMETER OF VALVE PORTS OF FILLER BOWL: 1 - 5/16 INCHES
1 - 9/16 INCHES
DIFFERENT

IF DIFFERENT, SPECIFY DIAMETER:

*SPECIFY WHICH TYPE OF COUNTER-PRESSURE CAP: TYPE A
TYPE B

*SPECIFY HOW CURRENT VALVES (SNIFTS) ARE MOUNTED IN THE VALVE RETAINER:

ANGLED AS IN "A"
PERPENDICULAR AS IN "B"

*DOES FILLER HAVE NECK SUPPORTS FOR PET BOTTLES?

ALL
SOME
NONE IF SOME, LIST BOTTLES THAT DO HAVE NECK SUPPORTS.

NECK SUPPORTS FOR:

*DOES FILLER HAVE CLEAN-IN-PLACE CAPABILITY (C.I.P.)?

YES
NO

IF YES SUPPLIED BY:

*PRESENT BOTTLES BEING RUN: LIST SIZE, TYPE, SIZE OF CLOSURE, HEIGHT OF BOTTLE, PRESENT B.P.M., DESIRED B.P.M. ie: 2 Ltr PET Generic, 28mm, 12.5", 120 bpm, 150 bpm.

*PRESENT BOTTLES:

NEW BOTTLES TO BE RUN: LIST SIZE, TYPE, SIZE OF CLOSURE, HEIGHT OF BOTTLE, DESIRED B.P.M. ie: 10 oz NR Glass, 38mm, 3.5", 450 bpm.

NEW BOTTLES:

REMARKS:

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