Company:

Address:

Division:

City:

State:

Post code:

Country:

Your Full Name:
Your Email address:

Telephone:

Fax:

Hose

Live    Single Hose    Storage Only    Dual hose    

Hose length:

Inside Diameter:

Outside diameter:

Bend radius:

Hose weight:

Flat hose dimentions:

Coupling spacing:

Type of product handled: (e.g. Liquid, Gasses, Oxygen/Acetylene, Hydraulic Fluid, Other, Temperature, Pressure. Please be specific)

Temperature:    Pressure:    

Hose Inlet Type (Hose Swivel):

Male    Female

90 degree    Straight    Special Material    Aluminium    Malleable Iron    
Stainless Steel    Bronze    Steel    Connector Size:

Hose Outlet Type (riser):

Male    Female

Size:
Thread
National Pipe Thread (NPT)    Joint Industry Committee (JIC)    National Standard Thread (NST)
British Standard Pipe (BSP)    Other

Cable

Live    Storage Only

Number of conductors required:

Outside diameter:

Bend radius:

Cable length:

Cable weight:

Amperage:

Voltage:

Check type of rewind.

Manual

Disk Rewind    Gear-drive crank    Direct crank    Chain-drive crank    

Power

Spring    Electric Voltage:    Air    Hydraulic    

Check type of installation:

Floor    Wall    Overhead    Vehicle    

Temperature range:

Environment:

Accessories (if any):

Finish (if other than standard):

Roller Assemblies:

Hose/Cable Stop:   Yes  No

Check type of installation and roller position for spring reels.

Lift

Stretch

Drag

Recovery/Pick up
No Roller

Roller

Position VR    Position SR    Position TR    Constant tension