After you have completed this form please print a copy for your own records
Device / pump information   Equipment Information   Distributor information   Customer Information  Comments
Form Type
 Product Order                         Request for Quotation 

Device/Pump Information

Configuration:   Direction of rotation viewed from bearing: 
Units of measurement: 
ØA (Sleeve OD)=  ØB (Box ID)=
C (To edge of flush port)=  D=
E (Box Length)=  ØF (Counter bore diameter note 3)=
G (Counter bore length note 3)=  Rings of packing Below=
Rings of packing Above= (3 or more note 2)  FO=

Material:         If other please specify:

Note: When using GLF radial cross section must be greater than .500"

Split or Solid                    Quantity 

Equipment Information

Flush:    If Yes, what is the flush rate? 

Make:    Model:    Size: 

Product:    %Solids:    Temperature: 

Distributor Information

Company:    Specialist:    

P.O.#:     
Customer Information
Company:   
Customer Name:    Approval (Type name):   
Position: 
Additional Comments
Comments:   
After you have completed this form please print a copy for your own records

 

 

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