First Name		Last Name
Title
Organization
Street Address		Address (cont.)
City		State/Province
Country		Zip/Postal Code
Work Phone		FAX
E-mail		URL

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First Name		Last Name
Phone		email

	What is the material ?	Resin Polymer Agricultural Chemical Filler Food Paint Pharmaceutical Other
	What is the material cost per pound (or kilo- indicate which)?
	Is the material hazardous?	N/A Yes No
	How well does the material flow?	Always flows well Flows well most of the time Doesn't flow well Very difficult flow
	How is material currently handled?	Paper bags Drums Gaylord containers FIBC Other
	What are the problems with current handling?
	What are the primary factors driving change in your methods?	Economics Safety Capacity Ergonomics Speed Flow rate control
	Vessels, Bags and Charge Site:
	How many batches are made each day per vessel?
	Is there more than one vessel?	N/A Yes No
	How many pounds (or kilo) of raw material per bag would you like?	Less than 1000 pounds (2200 kilo) 1000 to 2000 pounds (2200 to 4400 kilo) 2000-3000 pounds (4400 to 6600 kilo) More than 3000 pounds (6600 kilo)
	What does charge site look like (Space or Headroom Constraints)?	Lots of Room Limited Headroom Limited Floor Space Mezzanine Application
	Are forklifts utilized in the plant?	N/A Yes No
	Is portability (ability to move unloader) important?	N/A Yes No
	Flow rate and Partial Discharge:
	Would partial discharge be helpful for your recipes?	N/A Yes No
	Would ability to re-seal, re-store bag be helpful?	N/A Yes No
	Vendors, Grounding, Liners:
	Who are your primary raw material vendors - please list?
	Is static charge an issue (ie: Grounded Bags)?	N/A Yes No
	Is moisture or other concerns an issue (ie: Liners)?	N/A Yes No
	Recycling Service:
	Is recycling the bag an option with your material?	N/A Yes No
	Is full bag management service (pay per use) of interest?	N/A Yes No
	Funding, Next Actions:
	Is Capital Budget available?	N/A Yes No
	Are you interested in leasing or other alternative ownership plans?	N/A Yes No

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