Enclosed-Shape Bellows-Quote Request Form

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PROTECTIVE COVERS
ENCLOSED-SHAPE BELLOWS
|
QUOTE REQUEST FORM
Date
Address ____________________________________________
_______________________________________________________
Company Name
______________________________________
City ____________________________ State/Prov. __________
Contact
_____________________________________________
Country ____________________ Zip/Postal Code __________
Quantity
____________________________________________
Telephone ___________________ Fax ___________________
Email _______________________________________________
1. Application Information
New or Replacement Application:
New Design
Replacement
Protection For:
Cylinder rod/ram
Rod with ball bushing
Ball screw
Acme screw
Spline
Rectangular-shaped part
Other (describe or send drawing) ______________________________________________________________________
Cover Orientation:
Horizontal
Vertical
Construction Preference:
Dynatect Recommendation
Gortiflex®-Molded
Sewn
Vulca-Seal®
Thermiseal
Folded
Cover Profile Shape:
Round
Oval*
Rectangular/Square
Tapered*
Other/Custom
*Drawing required; PDF or DWG/DXF file preferred.
2. Operation Information
Continuous (ambient) Temperature: __________________
°F
°C
Intermittent Temperature Range:
Min. __________ Max. __________
Frequency of Exposure: ________________________________________
Distance from Heat Source (if applicable)*: ________________________________________
Maximum Travel Speed*: ____________________ Movements/Day ___________________
Acceleration*: _____________________________
Pressure ______________ PSI
Bellows cycles under pressure
Vacuum ______________ PSI
Bellows cycles under pressure
*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
Camera/Light-Proof
Other (specify) __________________________
Regulatory Compliance:
Standard _________________________
Bellows must be fire retardant (list standard to the left)
Application Notes: ___________________________________________________________________________________________________
30
Phone: 262-786-1500 or 800-298-2066 | Fax: 262-786-3280 | Email: |

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