Free Application Evaluation Form Siemens Machine Vision
Fields marked with an asterisk (*) are mandatory.

End User Contact Information
Name*
Company / Organization*
Title
Address
Address 2
City
State / Province
Country
Zip / Postal Code
Email*
Phone Number*
Siemens sales or partner known?
Yes No

Application Information
Please briefly describe your application*
How many systems do you expect to install?*
What is your install date?

If available, please provide the following pieces of information about your parts, production line and application type(s) to allow us to best evaluate your requirements.

Part name/type*
Part min. width Part max. width
Part min. height Part max. height
Part min. length Part max. length
Inspection mode
Production rate
(parts/minute)
Part is moving?
Line speed*
Cycle time
(secs)
Inspection time
available*
(msecs)
How many types
of parts?*
Number of lines
Number of systems
per lines
Number of cameras/
readers per system
(if known)

Application type (please check all that apply)
Identification / Traceability
Bar Code Reading
Data Matrix Reading
Data Matrix Verification
OCR (Optical Character Reading)
Other Inspection
Counting
Dimensional
Flaw Detection
OCV (Optical Character Verification)
Presence / Absence
Gauging
Part Location / orientation for robot / machine guidance
I/O
Analog
Digital
Communications / Networking
Ethernet
Profibus
RS232 Serial
Other (please define)

Environmental, Lighting and Mechanical Variables
Any environmental factors? (temperature, dirt/dust, moisture, etc.)
Any lighting restrictions or mechanical clearance issues?

Part Samples, Specifications and Form Submission
Part samples and specifications are required for us to complete most application evaluations
Can you provide samples for us to evaluate?*
Yes No
Do you need the samples returned?
Yes No
May we use images of your part for training purposes?
Yes No
Can you provide a specification?*
Yes No
Additional Comments
How did you hear about us?

Siemens Machine Vision