Product Request Form

Company Name

Name

Phone Number

Email*

Country of Operation

1. Truck Type (choose one)

AN/FO (AN prill only – auger delivery only)

Heavy AN/FO (AN prill or blend w/ Emulsion – auger delivery only)

Pump Blend (Emulsion or blend w/ AN prill – pump delivery only)

Heavy Blend (AN/FO – Emulsion: auger or pump delivery)

Pump (Emulsion only – pump delivery only)

2. Unit Configuration (Choose one)

AN/FO Truck Options:

Overhead auger behind cab

Overhead auger at rear

Side auger

Hose reel behind cab

Hose reel at rear (discharge facing driver side)

Hose reel at rear (discharge facing back)

Hose reel at rear (180º swivel)

Hose reel boom at rear (180º swivel)

Hose Length

Hose Diameter

3) Tank Capacities

Ammonium Nitrate (AN)

lbs

kgs

Emulsion

lbs

kgs

Product Density

4) Discharge Rate

Auger delivered product

lbs

kgs

Min

to Max:

Pumped delivered product

lbs

kgs

Min

to Max:

Mix Plants – Types

A-10 Mixer: For blending simple prilled AN and fuel oil for bagged AN/FO

Valve Bagger

Cartridge Packer

Other

Product Request Form

Equipment

Contact Information