HOSE ASSEMBLY REQUEST FORM
Please fill out the inquiry form to let us know your needs.
Customer contact
Company
Address
TEST
Pressure
Vacuum
Untested
SIZE: I.D.(mm), O.D.(mm), Hose Length(m), Assembly Length(m), Quantity
TEMPERATURE: (Material conveyed)Internal-Max/Min(°C), (Environment)External-Max/Min(°C)
APPLICATION: (Conditions of use)
Suction & Delivery (Pressure)
Delivery (Pressure)
MATERIAL: (Material being conveyed)
Water
Air
Abrasives
Steam
Petrol/Oil
Chemical
PRESSURE: (Assembly will be exposed to)kPa/PSI/Bar
ENDS: (Orientation, style, type) Fitting 1
ENDS: Hose
ENDS: (Orientation, style, type) Fitting 2
ENDS: (Attachment method) Fitting method
Crimp Ferrule: Alum
Crimp Ferrule: SS
Crimp Ferrule: Plated Steel
Clamps: Worm
Clamps: T Bolt
Clamps: Semi SS
Clamps: Full SS
Bolt: Standard Double
Bolt: Safety Claw 2-Bolt
Bolt: 4 & 6 Bolt
Delivery(Testing, quality packing, time)
Collect(NO.153-15, CHUNG HSIN N. ST., SANCHONG DIST., NEW TAIPEI CITY 241, TAIWAN)
Courier(DIWU to provide courier)
Transport(DIWU to provide Transport)
Special Instructions
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