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Please fill out as much information as you have, then fax to #800-334-3283. You can also download the Interactive PDF Version if you prefer
Date:________________ Co. Type: __OEM __Reseller __Consultant __End User
Company Name/Address:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Contact Information:
Name: ___________________________________________________
Phone #: _________________________________________________
Fax #: ___________________________________________________
E-Mail Address: ____________________________________________
Project Name:_____________________________________________
Projected annual usage: ______ New Project? ____ Future Project? ____Retrofit?
If retrofit: Make/serial number of current ring: ____________________________
___________________________________________________________________
Application (describe how is the ring to be used?): _____________
___________________________________________________________
___________________________________________________________
___________________________________________________________
ENVIRONMENTAL DATA:
Ambient temp range: _________________Vibration?_____ Humidity?_____
Other contaminents present? (describe):
___________________________________________________________________
Will you want an enclosure from Conductix-Wampfler? If so how much sealing is required (specify below):
___NEMA 1 wrap cover (indoor); ___NEMA 12 (indoor dripping water);
___NEMA 3R (outdoor vented); ___NEMA 4 (water and dust tight);
___NEMA 4X (corrosion-resistant); ___NEMA 9 (Explosion-Proof)
Is a certain I.P. Rating Required?_________
Is 3rd Party Certification/Listing Required (describe):_______________________
Do you need other special attributes? (heater strips, drains, air/water pass-thru, special mounting hardware, etc.)______________________________________________________________
______________________________________________________________
______________________________________________________________
MECHANICAL DATA:
Rotational speed?___________________RPM
Duty cycle (describe)______________________________________________
Ring mounted horizontally or vertically? ______________________
Maximum size envelope __________ dia x ___________ length
Thru bore required?____________ inches
What devices will be required with the ring? (encoder, air swivel, etc. - describe):
____________________________________________________________
____________________________________________________________
Do you have other mounting details? (attach drawing/sketch)
ELECTRICAL DATA:
Specify number of rings required at each ampacity/voltage, and describe what the conductor is used for (ie: motor, heater, control, limit switch, soleniod, etc. If signal, describe the type and parameters.)
____ rings @ ______ cont. amps ______ max amps ______ volts: For __________________________
____ rings @ ______ cont. amps ______ max amps ______ volts: For __________________________
____ rings @ ______ cont. amps ______ max amps ______ volts: For __________________________
____ rings @ ______ cont. amps ______ max amps ______ volts: For __________________________
____ rings @ ______ cont. amps ______ max amps ______ volts: For __________________________
____ rings @ ______ cont. amps ______ max amps ______ volts: For __________________________
____ rings @ ______ cont. amps ______ max amps ______ volts: For __________________________
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