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CONTACT INFORMATION
Company Name:
Address1:
Address2:
City:
State:
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Zip:
Country:
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Contact First Name:
Contact Last Name:
Contact Title:
Phone:
Fax:
Email:
BASIC INFORMATION
Industry:
Can Lining
Car Wash
Converting
Corrugating
Customs
Distributors
Farm Equipment
Food
Glass
High-Pressure Cleaning
Laminating
Machine Tool / Auto - OEM
Machine Tool / Auto - User
Marine
Mining Equipment
Other
Packaging
Paper
Plastic
Printing
Resellers
Semi-Conductor
Steel
Textile (Non-Woven)
Tire and Rubber
Windmills
Wire and Cable
Other:
Company Type:
OEM
End-User
Location:
Equipment:
Application:
Motion:
Continuous
Intermittent
Oscillating
Indexing
Swivel
Configuration:
End of Shaft
Around the Shaft
In the Shaft
Quantity:
Target Price:
Replace Competitors Union?
Yes
No
If yes, why?
Price
Performance
Convenience
Competitors Name:
(if applicable)
Competitors Model #:
(if applicable)
Media:
Speed (RPM):
Feet Per Minute:
Roll Diameter:
(inches)
Pressure:
(PSI)
(Bar)
Temperature:
°
F
°
C
Hose Connection Port:
Threaded
Flanged
Other
Other:
Hose Connection Port Size:
Hose Connection Port Size Type:
NPT
BSP
PT
Hose Connection Port Position:
90 degrees
Straight
Rotor Connection:
Threaded
Flanged
Rotor Connection Type:
NPT
BSP
PT
Straight Thread
Other
Other:
Rotor Connection Size:
Rotor Connection Rotation:
RH
LH
Rotor Connection Bolt Circle:
Rotor Connection O.D.:
Rotor Connection I.D.:
Rotor Connection Pilot Diameter:
Number of Passages:
Mono
Duo
Other
Other:
SPECIAL SECTION
Operating Union with Periodic Absence of Coolant?
Yes
No
Pressurized
Unpressurized
Bearing Support:
Bearingless
Bearing Supported
Coolant Type:
Water-Based
Oil-Based
How often does union operate with absence of coolant?
How long is absence of coolant cycle?
Is there "residual" coolant in line?
Yes
No
Filtration:
micron(s)
Installation:
Vertical Installation
Horizontal Installation
Angular Installation
Siphon Type:
Stationary Siphon
Rotating Siphon
Siphon Size:
Lubricated Air?
(Air/Hydraulic Applications)
Is Inter-Passage leakage acceptable?
(Multi-Passage Applications)
MISCELLANEOUS SECTION
Date required for Quote:
January
February
March
April
May
June
July
August
September
October
November
December
/
/
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Date required for Union:
January
February
March
April
May
June
July
August
September
October
November
December
/
/
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
# Prototypes Needed:
(if applicable)
Description:
(add comments as required)
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