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Customer Company Name*

Customer Address*

City State / Province / Region Country

Contact Name*

First Last

Contact email*

Contact phone number*

Plant/mine location

Source of material

Mineral products to be recovered

Gangue/By-product mineral(s) to be rejected

Median particle size in micron or US mesh

Maximum particle size in micron or US mesh

Moisture content in wt. %

Feed rate required for separator in metric tonne per hour

Ultimate feed available for processing in tonnes, or tonnes per year

Mineral product purity/quality goal

Mineral product recovery goal %

What is the price of Fly Ash in your marketplace

Comments/Materials to Beneficiate*

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