PolyMod Technologies

Engineering/Technical Request

All information submitted on this IDS including any attached information, such as hardware
drawings, will be considered confidential information and treated as such by PolyMod Technologies Inc.


  NOTE: Fields and sections marked by an asterick (*) are mandatory.

*Name:

*Title:

*Company:

Division:

*Address:

P.O. Box:

*City:

*State/Province:

*Postal Code:

*Country:

*Phone:

Fax:

 *E-mail:


  APPLICATION:

*Please check one: New Currently In Use

*Equipment:

  Model:

Components:

*Describe Application:

Existing Seal Type:

  Material:

Manufacturer:

  Part Number:

What has been tried in the past with this application?


*REASON FOR INQUIRY:


ADDITIONAL REASON FOR INQUIRY:


FURTHER REASON FOR INQUIRY:


Notes:


*HARDWARE SPECIFICATIONS:

  Please specify dimensions, tolerances, and overall shape. If possible, please E-mail or Fax us your specification and drawing/sketches.


*Can hardware be changed? No Yes

*Gland type:

     

*Hardware specification:

     
Dash Size: Back-up Width:
Number of Back-ups: Material:


*ENGINEERING DATA:

*Choose One Motion:  

Operating Parameters

Unit (Select One)

Minimum

Operating

Maximum

Temperature:

°F °C

Pressure:

psi bar MPa
Pressure Direction: Unidirectional Bidirectional

Load:

Lbs kg

Constant Fluctuating Shock

Vacuum:

in. Hg. Torr

Gland/Housing Material(i.e. 7075 AI):

Surface finish (i.e. 16Ra, 70% Rmr):

Mating Sealing Surface Material(i.e 303 SS):

Surface finish (i.e. 16Ra, 70% Rmr):

Fluids/Gasses (specific type):

Contaminants:

Lubrication (specify type):

 
*PERFORMANCE REQUIREMENTS:

Friction: Lbs oz g

Breakout

Dynamic

Torque: ft/lb in/oz g/cm

Breakout

Dynamic

Required Life: Cycles hrs yrs

Max. Leakage: drops cc/min

*Most Critical Aspect:


TEST PROGRAM:

Start Date:

Anticipated Completion Date:

Test Details:

*DECISION AND TIMING:

*Estimated:

Prototype order need date and quantity:

First production need date and quantity:

OTHER DETAILS:

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PolyMod® Technologies Inc.

AS9100C & ISO 9001:2008
Registered QMS

P.O. Box 10180
Fort Wayne, IN 46851-0180 USA
Phone : +01 (260) 436-1322
Fax : +01 (260) 432-6051
Email : sales@polymod.com