END USER – (   ) AUTOMOTIVE   (    ) OTHER_______________________________________

APPLICATION INFORMATION:  (    ) BUDGETARY ONLY     (    ) WILL PURCHASE_______

DESCRIPTION:_________________________________________________________________

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FEED RATE: ___________  SCREWS (ETC) PER/MIN.   QTY OF SCREWS ETC /P ASS’Y _____

TORQUE: ___________    IN#     Nm 

DRIVE DIRECTION: <HORIZONTAL> <VERTICAL UP>  <VERTICAL DOWN>

SCREW INFORMATION:              (    ) PRINT ATTACHED                 (    ) SEE SKETCH BELOW

DRIVE TYPE:  (    ) SLOTTED   (    ) PHILLIPS #____    (    ) POSI-DRIVE # ____     (    ) TORX #T- ____

(    ) ______ HEX     (   ) _______ HEX-WASHER W/______ DIA. WASHER

(    ) OTHER: - SPECIFY_______________________________________________________

SCREW OR NUT RUNNER – (    ) SKETCH BELOW           THREAD SIZE / TYPE_____________

ACCESS INFORMATION:  (    ) WIDE OPEN       (   ) RESTRICTED ACCESS  -  SEE SKETCH BELOW

WORKPLACE LAYOUT:    (    ) BENCH TOP   (    ) WORK CELL    (   ) CONVEYOR/PALLET   (    ) DIAL MACHINE        (    ) OTHER – SPECIFY_________________________________________________

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TYPE OF SYSTEM : (    )AUTOMATIC  (    )OPERATOR ASSIST (    )MANUALLY DIRECTED ON BALANCE ARM

OPTIONS : ____________________________________________________________________

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DRIVER/PLACING UNIT CONFIGURATIONS : (   ) NOSE/RECEIVER ONLY  (    ) WITH MOUNT        (    ) CUSTOMER MOUNT  (   ) NOSE/RECEIVER & DRIVE SPINDLE W/MOTOR MOUNT

TYPE OF DRIVE UNIT MOUNT: (   )SIDE LUG (   )FRONT FLANGE  (   )REAR FLANGE  (   )OFFSET FRONT   

(   )OFFSET REAR (   )MULTI-DRIVER MOUNT  (   )FIXED CENTERS   (   )ADJUSTABLE CENTERS 

(   )STAGGERED LEVEL

(   ) PROX. BRACKET & TARGET.   12mm SWITCHES SUPPLIED BY - (    ) CUSTOMER     (   ) Deane Systems

VALVE(S) TO OPERATE DRIVER SPINDLE(S) SUPPLIED BY - (    ) CUSTOMER     (   ) Deane Systems

ADDITIONAL ITEMS: ___ ___________________________________________________________

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DRIVE MOTORS ETC:

(   ) AIR MOTOR /BRAND & No. PREFERRED __________________________________________

(   ) DC ELEC. /BRAND & No. PREFERRED _____________________________________________

DRIVE MOTOR SUPPLIED BY - (    ) CUSTOMER    (   ) Deane Systems

(   ) AIR CYL. FOR PLACING ONLY/BRAND PREFERRED  ________________________________

(   ) PRESS PIN THRU NOSE/RECEIVER          (    ) CUSTOMER SUPPLIED PRESS

(   ) OTHER – EXPLAIN _____________________________________________________________

(   ) SIGNAL PORT ADAPTOR & PRESSURE SWITCH ( AIR MTR ONLY) CLUTCH KICK OUT VERIFICATION

ADDITIONAL ITEMS:  ______________________________________________________________

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PRIMARY SLIDES ETC:

(   ) PRIMARY SLIDE – (CIRCLE STROKE REQUIRED)    1”     2”    3”   4”    5”    6”   7”    8”  

(   ) ONE DRIVER PER SLIDE                           (   ) SLIDE ONLY

(   ) SLIDE WITH MOUNT FOR AIR or ELEC. DRIVE MTR ETC:

(   ) MULTI-DRIVER or PLACING UNIT MOUNTS (INDICATE TYPE - SEE CONFIGURATIONS  TOP OF THIS SHEET )

(   ) PROX. SWITCH ACTUATOR KIT.   12mm SWITCHES SUPPLIED BY -   (   ) CUSTOMER   (    ) Deane Systems

(   ) KWIK LATCH SLIDE MOUNT ( ALLOWS RAPID CHANGE OUT OF COMPLETE DRIVER & SLIDE UNIT)

ADDITIONAL ITEMS: _______________________________________________________________

FEEDER OPTIONS:

(    )  CASTER KIT W/LOCK   (    ) STORAGE BIN EXTENDER  (   ) BIN LEVEL SENSOR

(    ) OMIT PLC    (    ) OMIT VALVES FOR ELEVATOR & ESCAPEMENTS

(   ) Deane Systems  ELECTRICAL & PNEUMATIC STANDARDS SUBMITTED TO CUSTOMER:

                 (  ) AS SHOWN (   )  AS MARKED

ADDITIONAL ITEMS:_______________________________________________________________

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