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CUSTOMER INFORMATION
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*Name:
Title:
Company Name:
Company Address:
City:   State:   Zip:   
Country:
*Email Address:
Telephone Number:
Fax:
Type of Business:
Is Secrecy Agreement Required? Yes No
Type of Proposal Required: Budgetary Firm
Proposal to include:

     Internals only

     Extraction column (shell and internals)

     Complete modular extraction system installed in structural frame

Date Proposal Required:

PROCESS INFORMATION
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General Process Objective:

Feed Composition (Specify weight percents or flowrates of ALL components):

Solute to be removed:
Desired solute concentrations?
     Extract:
     Raffinate:
Preferred solvent (if known):
Is solvent present on site?: Yes No
Equilibrium distribution coefficient (if known) [dimensionless]:
Interfacial tension for top and bottom of column (if known) [dyne/cm]:
Do you have previous experience with this application?: Yes No
Are there any suspended solids?: Yes No Wt%: Size [m]:
Type of extractor preferred (if known): Packed Tray Agitated None
Space limitations (if any): Diameter [ft]: Height [ft]:
Materials of Construction:
          Shell:
          Internals:

Other Notes or Comments:

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