Order of Confirmation Form
(Print out the inforation and Fax back to us)

Name 
Company 
Address 
City      State      ZIP 
Phone      Ext. 
Fax 
Email 
Electricity:  V;  Hz;  Phase;    PlugType  (USA/Europe)
Conveyor Specification:  Length  (mm);    Width  (mm)
Converyor Direction ?  Left to Right ;  Right to Left
Type Belt   ? Standard   ;  Other
Applicator  ?  120  ;    150 ;    180 ;    Other
Printer ?         Included                  ;             Not Included

Optional:

Turn Table:

  Feeder:

  Collecting Plate:

  Other:

(Indicate Y to select the optional item)

Label description:  (adhesive?     label size?     substrate applied to ?)

Machine function:

Special requirement:

Special design:

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Pack Leader Co., Ltd.
TEL    : 886-4-22703942

FAX    : 886-4-22703943