Request Information - KISS Packaging

Request Information Form
Customer Information
Company		Type of Company:
Contact		Your Title/Position
Email		Telephone	Ext ;
Address1		Fax
Address2		Sales Rep
City		Preferred Method
State	Zip	Country
Highlighted fields must be filled in.

Inquiry Information

Inquiry Type

Request Literature
Quote
Sales Call
Other

What products of ours are you interested in?

Fillers	Cappers
Labelers	Sleeve Labelers
Heat Tunnels	Material Handling Equipment
Bottle Washers	Used Equipment
Entire Accutek Packaging Line
Other

Referred By:

Machinery Budget

If you know the exact machine(s) you're interested in, please fill in the box to the right with that information.

Project Details

If you would like a have more detailed feedback, please continue with the rest of the form. Otherwise you may click Submit Form to to send.

Container, Cap, and Label Specifications
Container Size(s) Example: 16oz, 10-16ml
Container Type	Other
Container Composition	Other
Container Shape	Other
Neck ID(s). Example: 1, 1.5, 2
Cap Type	Other
Cap Size(s). Example: 24mm, 2"
Label Application
Label Dimensions

Product Specifications
How many products do you fill?
Fill Size(s) Example: 1, 8, 16 or 10ml - 16oz
Product Type(s) or Name(s). Example: Cosmetic; Shampoo & Hair Styling Gels
Product Viscosity Range (CPS)	If all of your products are water-thin check this box ?
Does the product foam?	Yes No
Does the product have particulates (chunks)?	Yes No
Fill Temperature	Other
Type of Fill	Other
Contact Parts	Other
Seals	Other
Other Characteristics (corrosive, etc.)

Other Specifications
Fill Speed	Containers Per Minute	Direction	Left-to-Right Right-to-Left
Conveyor Chain	Other	Electrical	V Ph Hz
Conveyor Height		Explosion Proof
Additional Information
(For all machinery orders we will most likely require sample containers, product, relevant sketches or diagrams.)

1399 Specialty Drive, Vista, CA 92081 • Phone: 760.734.4177 • Fax: 760.734.-4188