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Company Name:
Company Address:
City, State, Zip:
Technical Contact:
Phone:
Fax:
E-Mail (If Applicable):
Overall Length of Control Needed:
Stroke length:
Compression Load:
Maximum:
Working:
Tension Load:
Maximum:
Working:
Temperature:
Maximum:
Working:
Type of equipment the control
will be used on and for what
purpose:
Life cycles required:
(Describe number of cycles per
minute, hour or day.)
Protection required against:
Water
Dust
Corrosion
Other (Explain)
Quantity of controls:
Special instructions or other
requirements:
Approximate delivery date:
