Conveyor Belt Order Sheet

Conveyor Belt Selection

St. Louis Factory Supply, Inc.

Conveyor Belt Order Sheet
Fill out completely, then click FILE and PRINT. This will print out the form for faxing into
St. Louis Factory Supply Inc.
When filled out completely the data will provide necessary information in selection
of proper conveyor belt for a specific conveyor belt recommendation.

Name:
E-Mail:
Street Address:
Address 2:
City:	State: Zip:
Phone:	FAX number: Date:
Conveyor ID:
Representative:

Material:	%fines:	Lump size:	Wt/Cu Ft:
	Max Temp:	Avg Temp:	Oil Cond:

	Abrasion:		Other Conditions:
	Belt Length:	Belt Width:	Belt Speed:F.P.M.

conveyor setup:

USDA or FDA YES NO

If Horizonal give C-C Ft.	If Incline give C-C Ft.	or Contour give C-C Ft.
and Vertical give C-C Ft.	or Angle of slope

DRIVES:

No. Drive Belt Pullys:
Arc of Contact
Motor Type
Type of Starting

Location:

Warp:

IDLERS:

Idler Angle

Spacing: CarryingFt.In.
Diameter Carrying:
Type
Special... Describe:

Return: Ft.In.
Return: In.

Loading: Type: Spacing:Ft. In.

Take up	Takeup TravelFt. In.
Takeup Location: Actual Take up Weight:
Splice: Valcanized Splice Mech. Fastner: Fastner Type:

Pully Diameters: DriveIn.
Take up:In.

Drive Snub: DriveIn.
Take up Bend:In.

Head: DriveIn.
Tail:In.

Head Snub: DriveIn.
Trupper:In.

Loading Conditions From: Loading Point:

Total Vertical Drop: Ft. (made up of Ft. free fall and Ft. of Vertical
Height on Loading Chute at º angle to horizontal)

Discharge End	Plow	Tripper	Lift Ft.
Other			(Describe) Ft.

Previous Conveyor Belt: Width In. Fabric: Plies:
Quality Top Cover Pully Cover
Manufacturer Life

Pattern of belt failure Cover worn off	Ply Seperation	Carcass Breaks	Other
(Describe)

24-HOUR SERVICE 1-866-234-2358

1-866-234-2358
[Phone]

(314) 842-6969
[FAX]

(314) 842-1526