For further comprehensive information or special problems, please complete as much of this questionnaire as possible and enclose a drawing (or rough sketch if drawing not available) to assist us in submitting the most suitable recommendations for your hose or conduit applications.
Please note: Fields marked * are required.
  
   
Conditions of Use  
Outside contaminants (if any):
  
Conveyant:
  
Rate of flow:
  
* Working pressure (psi or bar):
  
Peak pressure (psi or bar):
  
Details of any impulse pressure:
  
* Temperature range (?c or ?f) inside:
  
* Temperature range (?c or ?f) outside:
  
Relative motion-dynamic:
  
Min-bend radius measured to inside of bend:
  
Details of vibration, frequency amd amplitude:
  
Flexing:
  
   
Hose Data  
Type of tubing preferred:
  
* Nominal bore diameter (in or mm):
  
Overall length (in or mm):
  
   
End Fitting Details  
Type (if standard):
  
   
Supply Conditions  
Special inspection requirements:
  
Number of assemblies required:
  
   
Your Details  
* Name of Organisation:
  
* Address:
  
* Contact:
  
* Position:
  
* Phone No:
  
* Email: