Bellows Way Cover - Quote Request Form
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1
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3PROTECTIVE COVERS
BELLOWS WAY COVER
|
QUOTE REQUEST FORM
Date
Address ____________________________________________
_______________________________________________________
Company Name
______________________________________
City ____________________________ State/Prov. __________
Contact
_____________________________________________
Country ____________________ Zip/Postal Code __________
Quantity
____________________________________________
Telephone ___________________ Fax ___________________
Email _______________________________________________
1. Application Information
(Please supply a sketch/drawing/CAD file (DWG or DXF file format)/photo of your application.)
New Design or Replace Existing Cover:
New cover design (only fill out pages 32 and 33)
Replace existing cover (only fill out pages 32 and 34)
Describe the type of equipment or part you need to cover: _________________________________________________________________
Machine Make: __________________________________________
Machine Model: __________________________________________
Cover Orientation:
Horizontal
Vertical
Cross Rail
Construction Preference:
Dynatect Recommendation
Heat-Sealed
Sewn
Vulca-Seal®
Sewn/Folded
2. Operation Information
Continuous (ambient) Temperature: ________
°F
°C
Intermittent Temperature Range: Min. ________ Max. ________
°F
°C
Frequency of Exposure: _____________________________ Distance from Heat Source (if applicable)*: _____________________________
Maximum Travel Speed*: _____________________ Movements/Day _____________________ Acceleration*: _____________________
*Please indicate unit of measurement for each value.
3. Environmental Information
Heat Exposure:
Weld Splatter
Hot Chips/Swarf
High Ambient Temperature (specify in “Operation Information”)
Abrasion Exposure:
Metal Chips/Swarf
Wood Chips/Shavings
Light Particles/Dust
Other ____________________________
Chemical or Liquid Exposure:
Water
Moisture
Salt or Sea Spray
Petroleum/Hydrocarbons
Oils (non-petroleum)
Hydraulic Fluid (petroleum-based)
Hydraulic Fluid (phosphate ester-based)
Acid
Coolant
Cutting Fluid
Other (specify) __________________________________________________________________________
Contaminant Exposure Level:
Minimal
Occasional
Heavy
Miscellaneous:
UV/Ozone
Outdoors
Food-Grade/FDA
Laser Beam
Clean Room
Other (specify) __________________
Regulatory Compliance:
Standard _________________________
Bellows must be fire retardant (list standard to the left)
Application Notes: ____________________________________________________________________________________________________
4. Extended/Retracted/Travel Requirements
Specify extended and retracted length requirements, or indicate travel and we will
advise retracted length. (Extended length = retracted length + travel distance)
Dimensions specified in:
in
mm
(A) Extended Length: _______________
(B) Retracted Length: _______________
(C) Travel Distance: _________________
32
Phone: 262-786-1500 or 800-298-2066 | Fax: 262-786-3280 | Email: |
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