sai extrusion systems
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Questionnaire
CROSS HEAD QUESTIONNAIRE
(Request for Quotations and/or Purchase Orders)
1. Customer Name:
Contact:
Phone:
Ext:
Fax:
NOTE: Please fill in all applicable information:
II. Product Information  
A. Product Type/Class: (General)
(i.e., wire & cable, telephone, automotive, building, medical tubing, pipe)
B. Product Type/Name: (Specific)
C. Product Size : Minimum Maximum Product Shaped
(Dimensional Print Required)
(Y) (N)
D. Conductor/Core Type:
( i.e, Copper, Solid, Standard, Core Make up ( i.e, 3-Conductor with Ground)
E. Conductor/Core Size:
F. Production Requirements: Output Kgs./Hr. Line Speed: Meter/Min.  
G. Extrudate/Compound:
( i.e, PVC, PE, PP, Nylon, LLDPE, XLPE, HDPE)
H. Manufacture and Grade:
I. Extrudate Temperature:
( i.e, Degree C)
       
J. Extrudate Thicknesses (wall per layer)
( i.e, Thickness or Range of THickness for each Layer )
 
  Layer#1:  
  Layer#2:  
K. Stripe ( Width (%of Coverage Area):
( i.e, Should be expressed, Degrees of 360 or % of Diameter)
 
L. Other  
   
III. Extrusion Head Information:  
A. New Installation: (Y) (N)  
  Replacement Sai (Y) (N) Other  
  Mfg'r:   Model No./Size:  
B. Head Type: Crosshead: (Y) (N); Inline : (Y) (N)  
  New Design: (Y) (N); Similar to Dwg. No.  
C. Head Configuration: Model No. if Standard:
  Single Layer Single w/Stripes  
  Composite (Dual) Layer Stripes  
  Composite w/Stripes Number of Stripes:  
      Size of Stripe:  
  Other (Special/Describe):    
           
D. Centering: Adjustable (Y) (N) Fixed
E. Gum Space Adjustability Required : (Y) (N)
  Adjustable with: Tip (Y) (N) Die (Y) (N) Both (Y) (N)
F. Head (not flange) Support Required: (Y) (N) Lift Table (Y) (N)    
G. Head Operating Accessories Recommended.
H. Special Requests:
( i.e., Material, Coating, CV Adapter, Vacuum Adapter, Low Volume )
       
I. Power Voltage: 230/240; 460/480; Other (Specify):
  Phase: Single; Other(specify):
 
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