REQUEST FOR QUOTATION

Last Name:

First name:

Company:

Address:

City:

State:

Zip:

Country:

Phone:

Fax:

Email Address:

Technical Information

Quantity:

Inner Diameter (Inch or mm):

Wall Thickness (Inch or mm):

Material Type:

Overall Length (Ft or m):

Fitting (One Side):

Fitting (Other side):

Maximum Working Pressure:
(Pd/sq inch or bars)

Dynamic Pressure:
(Pd/sq inch or bars)

Static Pressure:

Vacuum:

Conveyed Product:

Working Temperature:

minimum

maximum

External Elements:
(example : abrasion, temperature, aggressive environment)

Bending Radius :

Movement:

Position on Machine:

Electrical Connection:

Yes

Special Assembling:

Test Pressure (invoicing):

Yes

Do you already have hoses in use for this application (which type)?

Further information or comments

The information included herein is furnished only as a general guide to aid in selecting products to suit the user�s application. No guarantee or warranty of performance is implied. The user assumes all responsibility in the use of these products. The information furnished is based upon historical data and is believed to be reliable. Warranties provided by the seller apply only to material quality and workmanship.