*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:

*REASON FOR INQUIRY:

Select Reason for Inquiry Improved Properties (Please check the most critical items) Problem with current seal/design (describe) New Design Cost Reduction Quote Request Problem (describe)

ADDITIONAL REASON FOR INQUIRY:

Select Reason for Inquiry Improved Properties (Please check the most critical items) Problem with current seal/design (describe) New Design Cost Reduction Quote Request Problem (describe)

FURTHER REASON FOR INQUIRY:

Select Reason for Inquiry Improved Properties (Please check the most critical items) Problem with current seal/design (describe) New Design Cost Reduction Quote Request Problem (describe)

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     If Yes, how?

*ENGINEERING DATA:

 
*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: