Mist Collector Qualification Form

Contact Name: Title:
Company:
Address: City:
State: Zip:
Country:
Phone: Extension:
Fax:
Email:
Application Data
Material(s) Machined: Process Hours per Day:
Coolant Type:  Synthetic Water Soluble Oil Coolant Pressure (PSI):
Number & Type of Machines Causing Problems
Machine Type: Avg. Cycle Time for Parts:
Number of Machines: Number of machines running simultaneously:
Are the machines enclosed?  Yes No Partly (if partial, list sizes of any fixed openings)
Mist Collection needed because of: (check all that apply)
 Safety Requirements Employee concerns/complaints Osha Epa Other
If other, please explain
Preferred Installation Method? Ducted Direct Mount
Are there any overhead obstructions that could impede the installation of an
overhead piece of equipment?  Yes No
Who, besides yourself, will be participating in the purchasing decision?
 Owner/President Proprietor Contractor/Engineer Other
If other, please list here:
What is the timeframe for the equipment need?
What budgetary amount has been assigned to this project?
Miscellaneous Comments:

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