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	First Name *

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	Address *

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	Email (we will keep your email completely private) *

	Website *

	Wash down required *
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	Direct food contact *
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	Product Description *

	Length
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	Width
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	Height
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	Maximum *

	Weight
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	Pieces per minute
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	Division size
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	Maximum *

	Label Size and Location *

	Scale Capacity *

	Top-of-Scale Height

	Scale Width *

	Scale Division Size *

	How is product entering scale? *

	How is product exiting scale? *

	Indicator *
	Yes No
	Host Computer with Touch Screen *
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	Type of scale top (example: roller top) *

	Additional comments *

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