RFQ

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Customer Name:

Title:

Company Name:

Street Address:

Address Line 2:

City:

State / Province / Region:

Zip / Postal Code:

Country:

Telephone:

Please include extension# or other pretainant information

Fax:

Email:

Technical Data

Application:
Gage Actuators Valve Manifold Other

Normal System Pressure:

Maximum System Pressure:

Proof Pressure:

Burst Pressure:

Fluid Media:
If Other please describe:

Flow:
Per Minute:
At Operating Pressure, PSI:

Vibration Requirements:

Other:

Electrical Enclosure:
Explosion Proof Flame Proof Fire Resistant Hermetically Sealed

Media Temperature:
Deg F High:
Deg F Low:

Ambient Temperature:
Deg F High:

Deg F Low:

Working Temperature:
Deg. F-

Size Limit:
Diameter (inches)-

Height (inches)-

Pressure Port Type & Size:

Other Port-

Other Design Considerations:

Brief Description of Application:

Please email circuit diagrams if available.

Estimated Annual Usage:

Target Price:

Delivery Schedule:

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