QUESTIONNAIRE FOR H&K BOTTLE FILLER

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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

PHONE: 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 NUMBER IF DIFFERENT:

 FAX NUMBER IF DIFFERENT:

*MODEL OF FILLER: DELTA VF
DELTA VVF
OTHER

 OTHER:

*NUMBER OF VALVES:

*NUMBER OF CAPPING HEADS:

 SERIAL NUMBER:

*DOES FILLER HAVE CENTERING DEVICES? YES
NO

IF YES, MANUFACTURER AND TYPE:

CENTERING CUP PART #:

SEALING RUBBER PART #:

*DOES FILLER HAVE NECK SUPPORTS FOR P.E.T. 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.) THROUGH THE VALVE?

YES
NO *ARE YOU NOW USING H&K C.I.P. CUPS ON VALVES? YES
NO

IF NO, 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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